51
|
Soliman RM, Elhaddad A, Oke J, Eweida W, Sidhom I, Ahmed S, Abdelrahman H, Moussa E, Fawzy M, Zamzam M, Zekri W, Hafez H, Sedky M, Abdalla A, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Fouad H, Tarek N, Abouelnaga S, Heneghan C. Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt. Int J Cancer 2020; 148:1562-1574. [PMID: 32997796 DOI: 10.1002/ijc.33321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022]
Abstract
Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P < .001) and by calendar periods from 69.6% to 74.2% (P < .0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P < .001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
Collapse
Affiliation(s)
- Ranin M Soliman
- Department of Continuing Education, University of Oxford, Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Menoufia University, Al Minufya, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Department, National Research Centre, Giza, Egypt
| | - Amr Abdalla
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Department of Paediatric Oncology, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Beni-Suef University, Beni-Suef, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Heba Fouad
- World Health Organization, Non-communicable Diseases Surveillance Unit, Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Chief Executive Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
52
|
van Heerden J, Kruger M. Management of neuroblastoma in limited-resource settings. World J Clin Oncol 2020; 11:629-643. [PMID: 32879849 PMCID: PMC7443833 DOI: 10.5306/wjco.v11.i8.629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/23/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuroblastoma (NB) is a heterogeneous disease with variable outcomes among countries. Little is known about NB in low- and middle-income countries (LMICs).
AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries (HICs).
METHODS PubMed, Global Health, Embase, SciELO, African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB, LMICs and outcomes. Only English language manuscripts and abstracts were included. A descriptive review was done, and tables illustrating the findings were constructed.
RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available. The disease characteristics varied among countries for the following variables: sex, age at presentation, MYCN amplification, stage and outcome. LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs. Implementation of evidence-based treatment protocols was still a barrier to care. Many socioeconomic variables also influenced the diagnosis, management and follow-up of patients with NB.
CONCLUSION Patients presented at a later age with more advanced disease in LMICs. Management was limited by the lack of resources and genetic studies for improved NB classification. Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.
Collapse
Affiliation(s)
- Jaques van Heerden
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
- Department of Paediatric Haematology and Oncology, Antwerp University Hospital, Edegem 2650, Belgium
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| |
Collapse
|
53
|
Kaspers GJL. COVID-19: how will this impact children with cancer, now and in the future? Expert Rev Anticancer Ther 2020; 20:527-529. [PMID: 32543935 DOI: 10.1080/14737140.2020.1781621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Gertjan J L Kaspers
- Pediatric Oncologist Director Academy and Outreach, Princess Máxima Center for Pediatric Oncology , Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| |
Collapse
|
54
|
Revon-Rivière G, Banavali S, Heississen L, Gomez Garcia W, Abdolkarimi B, Vaithilingum M, Li CK, Leung PC, Malik P, Pasquier E, Epelman S, Chantada G, André N. Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists. J Glob Oncol 2020; 5:1-8. [PMID: 31260397 PMCID: PMC6613668 DOI: 10.1200/jgo.18.00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Low- and middle-income countries (LMICs) experience the burden of 80% of new childhood cancer cases worldwide, with cure rates as low as 10% in some countries. Metronomics combines frequent administrations of low-dose chemotherapy with drug repurposing, which consists of using already-approved drugs for new medical applications. With wide availability, limited costs, and little infrastructure needs, metronomics can be part of constraint-adapted regimens in these resource-limited settings—with the understanding that metronomics shall not be a substitute for standard treatments when available and doable. Our study aims to describe the experience, practices, opinions, and needs in metronomics of physicians working in LMICs. METHODS An online questionnaire was sent to more than 1,200 physicians in pediatric oncology networks in LMICs. Items included the type of center, physician’s demographics, experience in pediatric oncology, and experience with current knowledge of metronomics. Opinions and perspectives were explored using multiple-answer and open questions. RESULTS Of physicians, 17% responded. Of respondents, 54.9% declared that they had already used a metronomic regimen. The most frequently cited repositioned drugs were celecoxib (44%) followed by propranolol and valproic acid (17%). Respondents highlighted the advantages of outpatient use (20%) and expected low toxicity (24%). In considering the drawbacks of metronomics, 47% of responses highlighted the lack of scientific evidence or guidelines, 33% the availability or affordability of drugs, and 18% the problem of acceptance or compliance. Of physicians, 79% believed that use of metronomics will spread in LMICs in the near future and 98% of them were willing to participate in international metronomic protocols or registries. CONCLUSION Metronomics is already used in LMICs and is a potential answer to unmet needs in pediatric oncology. There is room for improvement in the availability of drugs and a necessity to develop collaborative protocols and research to generate level A evidence.
Collapse
Affiliation(s)
| | - Shripad Banavali
- Metronomics Global Health Initiative, Marseille, France.,Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Laila Heississen
- Metronomics Global Health Initiative, Marseille, France.,Rabat Children Hospital, University Mohamed V, Rabat, Morocco
| | - Wendy Gomez Garcia
- Metronomics Global Health Initiative, Marseille, France.,Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Babak Abdolkarimi
- Metronomics Global Health Initiative, Marseille, France.,Lorestan University of Medical Science, Khorramabad, Iran
| | - Manickavallie Vaithilingum
- Metronomics Global Health Initiative, Marseille, France.,Netcare Parklands Hospital, Durban, South Africa
| | - Chi-Kong Li
- Metronomics Global Health Initiative, Marseille, France.,Prince of Wales Hospital, Chines University of Hong Kong, Sha Tin, People's Republic of China
| | - Ping Chung Leung
- Metronomics Global Health Initiative, Marseille, France.,The Chinese University of Hong Kong, Sha Tin, People's Republic of China
| | - Prabhat Malik
- Metronomics Global Health Initiative, Marseille, France.,All India Institute of Medical Sciences, New Delhi, India
| | - Eddy Pasquier
- Metronomics Global Health Initiative, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Aix-Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Sidnei Epelman
- Metronomics Global Health Initiative, Marseille, France.,Santa Marcelina Hospital, São Paulo, Brazil
| | - Guillermo Chantada
- Metronomics Global Health Initiative, Marseille, France.,Hospital JP Garrahan, Buenos Aires, Argentina
| | - Nicolas André
- Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, Marseille, France.,Metronomics Global Health Initiative, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Aix-Marseille Université, Institut Paoli-Calmettes, Marseille, France
| |
Collapse
|
55
|
Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, Lam CG, Ward ZJ, Yeh JM, Allemani C, Coleman MP, Di Carlo V, Loucaides E, Fitchett E, Girardi F, Horton SE, Bray F, Steliarova-Foucher E, Sullivan R, Aitken JF, Banavali S, Binagwaho A, Alcasabas P, Antillon F, Arora RS, Barr RD, Bouffet E, Challinor J, Fuentes-Alabi S, Gross T, Hagander L, Hoffman RI, Herrera C, Kutluk T, Marcus KJ, Moreira C, Pritchard-Jones K, Ramirez O, Renner L, Robison LL, Shalkow J, Sung L, Yeoh A, Rodriguez-Galindo C. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21:e185-e224. [PMID: 32240612 DOI: 10.1016/s1470-2045(20)30022-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
Collapse
Affiliation(s)
- Rifat Atun
- Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Avram Denburg
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Lindsay Frazier
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine G Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elizabeth Fitchett
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Fabio Girardi
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, King's College London, London, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Shripad Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Center, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Patricia Alcasabas
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and the School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas Gross
- Center for Global Health, US National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lars Hagander
- Department of Clinical Sciences Lund, Pediatric Surgery, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cristian Herrera
- Health Division, Organization for Economic Cooperation and Development, Paris, France; Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatrics, Division of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Karen J Marcus
- Department of Radiation Oncology, Harvard Medical School, Harvard University, Boston MA, USA; Division of Radiation Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Claude Moreira
- Institut Jean Lemerle, African Paediatric Oncology Formation, Dakar, Senegal; Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Kathy Pritchard-Jones
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Ramirez
- Department of Pediatric Haematology and Oncology, Centro Médico Imbanaco de Cali, Cali, Colombia; Cali Cancer Population-based Registry, Universidad del Valle, Cali, Colombia
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School Accra, Ghana; Paediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jaime Shalkow
- Department of Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico City, Mexico; School of Medicine, Anahuac University, Mexico City, Mexico
| | - Lillian Sung
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Yeoh
- Division of Paediatric Haematology and Oncology, National University Cancer Institute, Singapore National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
56
|
Carpenter K, Slone AK, Scheuer M, Mehta PS, Slone JS. Factors influencing diagnostic delays of pediatric cancers in Botswana. Pediatr Blood Cancer 2020; 67:e28182. [PMID: 31925921 DOI: 10.1002/pbc.28182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND A major barrier in improving cancer outcomes in Botswana and other low- and middle-income countries is timely access to care. Understanding time to diagnosis of pediatric cancers in Botswana and evaluating factors contributing to delays was necessary to inform interventions. METHODS A retrospective cohort study of children diagnosed with cancer at Princess Marina Hospital from 2008 to 2015 was performed utilizing the Botswana Pediatric Oncology Database. The time to diagnosis, pretreatment center delay, and pathology turnaround time were calculated. Time to diagnosis was analyzed using univariate and multivariate analyses to determine association with age, sex, distance to a treatment center, HIV status, cancer type, outcome, and presence of metastasis at diagnosis. RESULTS The median time to diagnosis was 10.7 weeks, median pretreatment center delay was 9.6 weeks, and median pathology turnaround time was 3 weeks. Longer time to diagnosis was significantly correlated with presence of metastasis at diagnosis. Age, sex, distance to a treatment center, HIV status, cancer type, and outcome were not significantly associated with diagnostic delay. CONCLUSION Children with cancer in Botswana have more than three months of symptoms prior to diagnosis, which is associated with metastasis at diagnosis. Efforts should be made to empower and promote awareness of pediatric cancer symptoms among caregivers and community healthcare providers in order to shorten time to presentation at a treatment center.
Collapse
Affiliation(s)
- Kendall Carpenter
- Princeton in Africa Fellowship, Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | | | - Michael Scheuer
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Parth S Mehta
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Jeremy S Slone
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| |
Collapse
|
57
|
Vasudevan L, Schroeder K, Raveendran Y, Goel K, Makarushka C, Masalu N, Zullig LL. Using digital health to facilitate compliance with standardized pediatric cancer treatment guidelines in Tanzania: protocol for an early-stage effectiveness-implementation hybrid study. BMC Cancer 2020; 20:254. [PMID: 32223740 PMCID: PMC7104518 DOI: 10.1186/s12885-020-6611-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In high-income countries (HICs), increased rates of survival among pediatric cancer patients are achieved through the use of protocol-driven treatment. Compared to HICs, differences in infrastructure, supportive care, and human resources, make compliance with protocol-driven treatment challenging in low- and middle-income countries (LMICs). For successful implementation of protocol-driven treatment, treatment protocols must be resource-adapted for the LMIC context, and additional supportive tools must be developed to promote protocol compliance. In Tanzania, an LMIC where resource-adapted treatment protocols are available, digital health applications could promote protocol compliance through incorporation of systematic decision support algorithms, reminders and alerts related to patient visits, and up-to-date data for care coordination. However, evidence on the use of digital health applications in improving compliance with protocol-driven treatment for pediatric cancer is limited. This study protocol describes the development and evaluation of a digital health application, called mNavigator, to facilitate compliance with protocol-driven treatment for pediatric cancer in Tanzania. Methods mNavigator is a digital case management system that incorporates nationally-approved and resource-adapted treatment protocols for two pediatric cancers in Tanzania, Burkitt lymphoma and retinoblastoma. mNavigator is developed from an open-source digital health platform, called CommCare, and guided by the Consolidated Framework for Implementation Research. From July 2019–July 2020 at Bugando Medical Centre in Mwanza, Tanzania, all new pediatric cancer patients will be registered and managed using mNavigator as the new standard of care for patient intake and outcome assessment. Pediatric cancer patients with a clinical diagnosis of Burkitt lymphoma or retinoblastoma will be approached for participation in the study evaluating mNavigator. mNavigator users will document pre-treatment and treatment details for study participants using digital forms and checklists that facilitate compliance with protocol-driven treatment. Compliance with treatment protocols using mNavigator will be compared to historical compliance rates as the primary outcome. Throughout the implementation period, we will document factors that facilitate or inhibit mNavigator implementation. Discussion Study findings will inform implementation and scale up of mNavigator in tertiary pediatric cancer facilities in Tanzania, with the goal of facilitating protocol-driven treatment. Trial registration The study protocol was registered in ClinicalTrials.gov (NCT03677128) on September 19, 2018.
Collapse
Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Kristin Schroeder
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Pediatrics, Division of Hematology/Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | | | - Kunal Goel
- Duke School of Medicine, 8 Searle Center Drive, Durham, NC, 27710, USA
| | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA
| | - Nestory Masalu
- Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | - Leah L Zullig
- Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton St, Durham, NC, 27705, USA
| |
Collapse
|
58
|
Ariffin H. Working together to fight childhood cancer in Asia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
59
|
Saab R, Belgaumi A, Muwakkit S, Obeid A, Galindo CR, Jeha S, Al-Rawas AH. The Pediatric Oncology East and Mediterranean (POEM) group – A regional collaborative platform for childhood cancer healthcare professionals. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
60
|
Abdelmabood S, Fouda AE, Boujettif F, Mansour A. Treatment outcomes of children with acute lymphoblastic leukemia in a middle-income developing country: high mortalities, early relapses, and poor survival. J Pediatr (Rio J) 2020; 96:108-116. [PMID: 30240631 PMCID: PMC9432263 DOI: 10.1016/j.jped.2018.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/07/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Acute lymphoblastic leukemia is the most common childhood cancer, yet surprisingly, very few studies have reported the treatment outcomes and the relapse rate of patients from low/middle-income countries. METHOD This study was a 5-year retrospective cohort study. It was conducted at Oncology Center of Mansoura University in Egypt and aimed to estimate the treatment outcomes and the relapse rates of newly diagnosed acute lymphoblastic leukemia in children. RESULTS Two hundred children suffering from acute lymphoblastic leukemia were studied; forty-six patients (23%) died during induction and most of those deaths were related to infection. Forty-one patients (27%) relapsed out of the 152 patients who achieved complete remission. The most common site of relapse was the bone marrow, followed by the isolated central nervous system, 53.7% and 31.7%, respectively. Seventy-eight percent of relapses occurred very early/early rather than later. The majority of relapse patients' deaths were related to infection and disease progression. The 5-year overall survival rate for patients was 63.1% (82.1% for non-relapsed compared to 36.6% for relapsed patients). CONCLUSION There was a high incidence of induction deaths related to infection and high percentages of very early/early relapses, with high mortalities and low 5-year overall survival rates. These findings suggest the urgent need for modification of chemotherapy regimens to be suitable for the local conditions, including implementation of supportive care and infection control policies. There is also a requirement for antimicrobial prophylaxis during induction period combined with the necessary increase in government healthcare spending to improve the survival of acute lymphoblastic leukemia in Egyptian children.
Collapse
Affiliation(s)
- Suzy Abdelmabood
- Mansoura University, Faculty of Medicine, Pediatric Department, Hematology/Oncology Unit, Al-Mansoura, Egypt
| | - Ashraf Elsayed Fouda
- Mansoura University, Faculty of Medicine, Pediatric Department, Hematology/Oncology Unit, Al-Mansoura, Egypt.
| | | | - Ahmed Mansour
- Mansoura University, Mansoura Faculty of Medicine, Mansoura Oncology Center - Pediatric Oncology Unit, Al-Mansoura, Egypt
| |
Collapse
|
61
|
Challinor JM, Day SW, Afungchwi GM, Alqudimat MR. Pediatric Oncology Nursing Research in Low- and Middle-Income Countries. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
62
|
Abdelmabood S, Fouda AE, Boujettif F, Mansour A. Treatment outcomes of children with acute lymphoblastic leukemia in a middle‐income developing country: high mortalities, early relapses, and poor survival. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
63
|
Ahmed AM, Al-Trabolsi H, Bayoumy M, Abosoudah I, Yassin F. Improved Outcomes of Childhood Acute Lymphoblastic Leukemia: A Retrospective Single Center Study in Saudi Arabia. Asian Pac J Cancer Prev 2019; 20:3391-3398. [PMID: 31759364 PMCID: PMC7063019 DOI: 10.31557/apjcp.2019.20.11.3391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Understanding the clinical and genetic characteristics of pediatric acute lymphoblastic leukemia (ALL) patients may help assigning the appropriate treatment. This study aims to understand patients’ characteristics, “real-world” treatment practice and outcomes of pediatric ALL. Methods: A cohort of 213 pediatric ALL patients, treated at (King Faisal Specialist Hospital and Research Center –Jeddah branch) KFSH and RC-J during the period of January 2002 to December 2015 were analyzed retrospectively. Statistical analyses were performed on patients’ demographic, clinical and genetics characteristics and outcomes of different treatment protocols. Survival was evaluated using Kaplan-Meier method, and differences in survival were tested using Log-Rank. Significance was set at 0.05 level. Results: Median age of the study cohort was 5 years (range 0.5–15 years) with 55.4% of male population. Majority of the patients had pre-B-cell ALL (88.7%), WBC count <50, 000/µL at diagnosis (76.1%, median = 13.5/µL with a range of 0.51–553.0/µL) with involvement of central nervous system (CNS) disease in 8.5%patients.Different common chromosomal anomalies or abnormalities, including t(12, 21) translocation, MLL genre arrangements, trisomy (4, 10, 17)and others, were detected. Early response to the risk-directed treatment received by the patients (91.1% achieving <5% blast in the bone marrow) as well as the end of induction outcome (96.2%) was encouraging. Conclusion: We found that the patients’ clinical characteristics and distribution of genetic abnormalities were similar to those of the western countries. Our findings show that the earlier gap between the western countries and KSA in terms of survival has been closed and that competitive outcomes can be achieved with local infrastructure.
Collapse
Affiliation(s)
- Abdullateef Mohammed Ahmed
- King Faisal Specialist Hospital and Research Center, Jeddah Branch, Alrawdah, Jeddah, Makkah, Kingdom of Saudi Arabia
| | - Hassan Al-Trabolsi
- King Faisal Specialist Hospital and Research Center, Jeddah Branch, Alrawdah, Jeddah, Makkah, Kingdom of Saudi Arabia
| | - Mohammed Bayoumy
- King Faisal Specialist Hospital and Research Center, Jeddah Branch, Alrawdah, Jeddah, Makkah, Kingdom of Saudi Arabia
| | - Ibraheem Abosoudah
- King Faisal Specialist Hospital and Research Center, Jeddah Branch, Alrawdah, Jeddah, Makkah, Kingdom of Saudi Arabia
| | - Fawwaz Yassin
- King Faisal Specialist Hospital and Research Center, Jeddah Branch, Alrawdah, Jeddah, Makkah, Kingdom of Saudi Arabia
| |
Collapse
|
64
|
Hessissen L, Patte C, Martelli H, Coze C, Howard SC, Kili A, Gagnepain-Lacheteau A, Harif M. African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa. J Glob Oncol 2019; 5:1-12. [PMID: 31657980 PMCID: PMC6825251 DOI: 10.1200/jgo.19.00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries. METHODS A 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training. RESULTS The first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site. CONCLUSION This training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.
Collapse
Affiliation(s)
| | - Catherine Patte
- Institut Gustave Roussy, Villejuif, France.,Paris-Sud University, Orsay, France
| | - Helene Martelli
- Institut Gustave Roussy, Villejuif, France.,Paris-Sud University, Orsay, France
| | - Carole Coze
- Hôpital d'Enfants de La Timone, Marseille, France
| | - Scott C Howard
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Mhamed Harif
- Ibn Rochd University Hospital, Casablanca, Morocco
| |
Collapse
|
65
|
Ramirez O, Aristizabal P, Zaidi A, Ribeiro RC, Bravo LE. Implementing a Childhood Cancer Outcomes Surveillance System Within a Population-Based Cancer Registry. J Glob Oncol 2019; 4:1-11. [PMID: 30241253 PMCID: PMC6223468 DOI: 10.1200/jgo.17.00193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Approximately 80% of cases of childhood cancer occur in low- and middle-income countries and are associated with high mortality rates. Assessing outcomes is essential for designing effective strategies to improve outcomes equally worldwide. We implemented a real-time surveillance system, VIGICANCER, embedded in a population-based cancer registry (PBCR) to assess childhood cancer outcomes. Methods VIGICANCER was established in 2009 as an integral part of Cali’s PBCR to collect real-time data on outcomes of patients (age < 19 years) with a new diagnosis of cancer treated in pediatric oncology units in Cali, Colombia. Baseline and follow-up data (death, relapse, treatment abandonment, second neoplasms) were collected from medical records, hospital discharge logs, pathology reports, death certificates, and the National Public Health Insurance database. A quality assurance process was implemented for the system. Results From 2009 to 2013, data from 1,242 patients were included in VIGICANCER: 32% of patients were younger than 5 years, 55% were male, and 15% were Afro-descendants. International Classification of Childhood Cancer group I diagnoses predominated in all age groups except children younger than 1 year old, in whom CNS tumors predominated. Five-year overall survival for all cancers was 51.7% (95% CI, 47.9% to 55.4%) for children (< 15 years), and 39.4% (95% CI, 29.8% to 50.5%) for adolescents (15 to 18.9 years). Five-year overall survival for acute lymphoblastic leukemia was 55.6% (95% CI, 48.5% to 62.2%). Conclusion Our study demonstrates the feasibility of implementing a real-time childhood cancer outcomes surveillance system embedded in a PBCR that can guide interventions to improve clinical outcomes in low- and middle-income countries.
Collapse
Affiliation(s)
- Oscar Ramirez
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Paula Aristizabal
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Alia Zaidi
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Raul C Ribeiro
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Luis E Bravo
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | | |
Collapse
|
66
|
Slone JS, Slone AK, Wally O, Semetsa P, Raletshegwana M, Alisanski S, Force LM, Chinyundo K, Margolin J, Agrawal AK, Anderson AR, Scheurer ME, Mehta PS. Establishing a Pediatric Hematology-Oncology Program in Botswana. J Glob Oncol 2019; 4:1-9. [PMID: 30241278 PMCID: PMC6223487 DOI: 10.1200/jgo.17.00095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose Annually, 300,000 children are diagnosed with cancer, and the majority of these children live in low- and middle-income countries (LMICs). Currently, there is incomplete information on pediatric cancer incidence, diagnosis distribution, and treatment outcomes in Africa. Since 2007, a pediatric hematology-oncology program has been operating in Botswana through a partnership between the Botswana government, Baylor College of Medicine, and Texas Children’s Hospital. Methods To better understand patient characteristics and outcomes at Botswana’s only pediatric cancer program, a hospital-based data base—the Botswana Pediatric Oncology Database—was established in 2014. Children younger than 18 years of age at the time of diagnosis who presented between 2008 and 2015 were included. Data for this study were extracted in February 2016. Results Of the 240 potential enrollees, 185 (77%) children met eligibility for this study. The median age was 6.4 years, and 50.8% were male. Leukemia was the most common malignancy representing 18.9% of the cohort and 88.1% of the total cohort had a histopathologic diagnosis. HIV seropositivity was confirmed in 13.5%. The 2-year overall survival of all pediatric cancer diagnoses was 52.4%. Abandonment of treatment occurred in 3.8% of patients. Conclusion In the first 9 years of the program, capacity has been developed through a longstanding partnership between Botswana and Baylor College of Medicine/Texas Children’s Hospital that has led to children receiving care for cancer and blood disorders. Although continued improvements are necessary, outcomes to date indicate that children with cancer in Botswana can be successfully diagnosed and treated.
Collapse
Affiliation(s)
- Jeremy S Slone
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Amanda K Slone
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Oaitse Wally
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Pearl Semetsa
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Mpho Raletshegwana
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Susan Alisanski
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Lisa M Force
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Kamusisi Chinyundo
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Judith Margolin
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Anurag K Agrawal
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Alan R Anderson
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Michael E Scheurer
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| | - Parth S Mehta
- Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA
| |
Collapse
|
67
|
Helal AE, Abouzahra H, Fayed AA, Rayan T, Abbassy M. Socioeconomic restraints and brain tumor surgery in low-income countries. Neurosurg Focus 2019; 45:E11. [PMID: 30269590 DOI: 10.3171/2018.7.focus18258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Healthcare spending has become a grave concern to national budgets worldwide, and to a greater extent in low-income countries. Brain tumors are a serious disease that affects a significant percentage of the population, and thus proper allocation of healthcare provisions for these patients to achieve acceptable outcomes is a must. The authors reviewed patients undergoing craniotomy for tumor resection at their institution for the preceding 3 months. All the methods used for preoperative planning, intraoperative management, and postoperative care of these patients were documented. Compromises to limit spending were made at each stage to limit expenditure, including low-resolution MRI, sparse use of intraoperative monitoring and image guidance, and lack of dedicated postoperative neurocritical ICU. This study included a cohort of 193 patients. The average cost from diagnosis to discharge was $1795 per patient (costs are expressed in USD). On average, there was a mortality rate of 10.5% and a neurological morbidity rate of 14%, of whom only 82.2% improved on discharge or at follow-up. The average length of stay at the hospital for these patients was 9.09 days, with a surgical site infection rate of only 3.5%. The authors believe that despite the great number of financial limitations facing neurosurgical practice in low-income countries, surgery can still be performed with reasonable outcomes.
Collapse
|
68
|
Sinha S, Brattström G, Palat G, Rapelli V, Segerlantz M, Brun E, Wiebe T. Treatment Adherence and Abandonment in Acute Myeloid Leukemia in Pediatric Patients at a Low-Resource Cancer Center in India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aim: One of the causes for lower cure rates in acute childhood leukemia in low- and middle- income countries (LMIC) compared to high-income countries is abandonment from treatment. The International Society of Pediatric Oncology (SIOP) defines abandonment as failure to begin treatment or an absence of 4 weeks during treatment. The aim of this study was to evaluate the extent of abandonment among patients diagnosed with acute myeloid leukemia (AML) at the pediatric ward at a low-resource cancer center in India. Methods: Medical records of all patients, aged 0–15 years, diagnosed with AML between January 1, 2014, and March 31, 2015, at the hospital were reviewed. Age, sex, date of diagnosis, and survival during the short follow-up time after completed treatment and information regarding abandonment were collected. SIOP definition of abandonment was used. Eight patients were diagnosed with AML at the hospital whereof 65 met the inclusion criteria of this study. Results: Of the included 65 patients, 6 died before treatment could be initiated and 3 were referred to palliative care upfront. Thus, 56 patients were offered curatively intended treatment. Of these patients, six refused treatment at this stage and another five abandoned during therapy. Altogether, 11 children abandoned treatment. Conclusion: In this study, the abandonment rate from treatment of childhood AML was 20%, which is in concordance from other studies conducted in India and other LMIC, stating that abandonment is a problem and hindrance when treating with a curative intent.
Collapse
Affiliation(s)
- Sudha Sinha
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | | | - Gayatri Palat
- Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
- Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Vineela Rapelli
- Palliative Care Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane
| | - Eva Brun
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University
- Department of Radiotherapy and Radiophysics, Skane University Hospital
| | - Thomas Wiebe
- Department of Clinical Sciences, Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
69
|
Denburg AE, Ramirez A, Pavuluri S, McCann E, Shah S, Alcasabas T, Antillon F, Arora R, Fuentes-Alabi S, Renner L, Lam C, Friedrich P, Maser B, Force L, Galindo CR, Atun R. Political priority and pathways to scale-up of childhood cancer care in five nations. PLoS One 2019; 14:e0221292. [PMID: 31425526 PMCID: PMC6699697 DOI: 10.1371/journal.pone.0221292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite increasing global attention to non-communicable diseases (NCDs) and their incorporation into universal health coverage (UHC), the factors that determine whether and how NCDs are prioritized in national health agendas and integrated into health systems remain poorly understood. Childhood cancer is a leading non-communicable cause of death in children aged 0-14 years worldwide. We investigated the political, social, and economic factors that influence health system priority-setting on childhood cancer care in a range of low- and middle-income countries (LMIC). METHODS AND FINDINGS Based on in-depth qualitative case studies, we analyzed the determinants of priority-setting for childhood cancer care in El Salvador, Guatemala, Ghana, India, and the Philippines using a conceptual framework that considers four principal influences on political prioritization: political contexts, actor power, ideas, and issue characteristics. Data for the analysis derived from in-depth interviews (n = 68) with key informants involved in or impacted by childhood cancer policies and programs in participating countries, supplemented by published academic literature and available policy documents. Political priority for childhood cancer varies widely across the countries studied and is most influenced by political context and actor power dynamics. Ghana has placed relatively little national priority on childhood cancer, largely due to competing priorities and a lack of cohesion among stakeholders. In both El Salvador and Guatemala, actor power has played a central role in generating national priority for childhood cancer, where well-organized and -resourced civil society organizations have disrupted legacies of fragmented governance and financing to create priority for childhood cancer care. In India, the role of a uniquely empowered private actor was instrumental in creating political priority and establishing sustained channels of financing for childhood cancer care. In the Philippines, the childhood cancer community has capitalized on a window of opportunity to expand access and reduce disparities in childhood cancer care through the political prioritization of UHC and NCDs in current health system reforms. CONCLUSIONS The importance of key health system actors in determining the relative political priority for childhood cancer in the countries studied points to actor power as a critical enabler of prioritization in other LMIC. Responsiveness to political contexts-in particular, rhetorical and policy priority placed on NCDs and UHC-will be crucial to efforts to place childhood cancer firmly on national health agendas. National governments must be convinced of the potential for foundational health system strengthening through attention to childhood cancer care, and the presence and capability of networked actors primed to amplify public sector investments and catalyze change on the ground.
Collapse
Affiliation(s)
- Avram E. Denburg
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adriana Ramirez
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Suresh Pavuluri
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Erin McCann
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Shivani Shah
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | | | - Federico Antillon
- School of Medicine, Universidad Franciso Marroquin, Guatemala City, Guatemala
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - Catherine Lam
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Brandon Maser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Lisa Force
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| |
Collapse
|
70
|
Lan BN, Castor A, Wiebe T, Toporski J, Moëll C, Hagander L. Adherence to childhood cancer treatment: a prospective cohort study from Northern Vietnam. BMJ Open 2019; 9:e026863. [PMID: 31383696 PMCID: PMC6687055 DOI: 10.1136/bmjopen-2018-026863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. DESIGN A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. SETTING The largest tertiary paediatric oncology centre in Northern Vietnam. PARTICIPANTS All children offered curative cancer treatment, from January 2008 to December 2009. PRIMARY AND SECONDARY OUTCOME MEASURES Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment. RESULTS Among 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03). CONCLUSIONS Non-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.
Collapse
Affiliation(s)
- Bui Ngoc Lan
- Pediatric Oncology Hematology Center, Vietnam National Children’s Hospital (VNCH), Hanoi, Vietnam
| | - Anders Castor
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Thomas Wiebe
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Jacek Toporski
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Christian Moëll
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Lars Hagander
- Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
71
|
Olbara G, Martijn HA, Njuguna F, Langat S, Martin S, Skiles J, Vik T, Kaspers GJL, Mostert S. Influence of health insurance status on childhood cancer treatment outcomes in Kenya. Support Care Cancer 2019; 28:917-924. [DOI: 10.1007/s00520-019-04859-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
|
72
|
Cai J, Yu J, Zhu X, Hu S, Zhu Y, Jiang H, Li C, Fang Y, Liang C, Ju X, Tian X, Zhai X, Hao J, Hu Q, Wang N, Jiang H, Sun L, Li CK, Pan K, Yang M, Shen S, Cheng C, Ribeiro RC, Pui CH, Tang J. Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children's Cancer Group. Arch Dis Child 2019; 104:522-529. [PMID: 30705079 DOI: 10.1136/archdischild-2018-316181] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Before 2003, most children with acute lymphoblastic leukaemia (ALL) abandoned treatment, with only approximately 30% treated in China. With the development of national insurance for underprivileged patients, we assessed the current frequency and causes of treatment abandonment among patients with ALL who were enrolled in the Chinese Children's Cancer Group ALL protocol between 2015 and 2016. METHODS Demographic, clinical and laboratory data on patients who abandoned treatment, as well as economic and sociocultural data of their families were collected and analysed. General health-related statistics were retrieved from publicly accessible databanks maintained by the Chinese government. RESULTS At a median follow-up of 119 weeks, 83 (3.1%, 95% CI 2.5% to 3.8%) of the 2641 patients abandoned treatment. Factors independently associated with abandonment included standard/high-risk ALL (OR 2.62, 95% CI 1.43 to 4.77), presence of minimal residual disease at the end of remission induction (OR 3.57, 95% CI 1.90 to 6.74) and low-income economic region (OR 3.7, 95% CI 1.89 to 7.05). According to the family members, economic constraints (50.6%, p=0.0001) were the main reason for treatment abandonment, followed by the belief of incurability, severe side effects and concern over late complications. CONCLUSIONS The rate of ALL treatment abandonment has been greatly reduced in China. Standard/high-risk ALL, residence in a low-income region and economic difficulties were associated with treatment abandonment. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-IPR-14005706, pre-results.
Collapse
Affiliation(s)
- Jiaoyang Cai
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, and National Children's Medical Center, Shanghai, China
| | - Jie Yu
- Department of Hematology/Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China
| | - Xiaofan Zhu
- Department of Pediatrics, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Shaoyan Hu
- Department of Hematology/Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Yiping Zhu
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Hua Jiang
- Department of Hematology/Oncology, Guangzhou Women and Children's Health Care Center, Guangzhou, China
| | - Chunfu Li
- Department of Pediatrics, Southern Medical University Affiliated Nanfang Hospital, Guangzhou, China
| | - Yongjun Fang
- Department of Hematology/Oncology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Changda Liang
- Department of Hematology/Oncology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Xiuli Ju
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Tian
- Department of Hematology/Oncology, Kunming Children's Hospital, Kunming, China
| | - Xiaowen Zhai
- Department of Hematology/Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Jinjin Hao
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Union Hospital, Wuhan, China
| | - Qun Hu
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
| | - Ningling Wang
- Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Hui Jiang
- Department of Hematology/Oncology, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Lirong Sun
- Department of Pediatrics, Qingdao University Affiliated Hospital, Qingdao, China
| | - Chi Kong Li
- Deparment of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kaili Pan
- Department of Hematology/Oncology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Minghua Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Shuhong Shen
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, and National Children's Medical Center, Shanghai, China
| | - Cheng Cheng
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Raul C Ribeiro
- Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - Jingyan Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, and National Children's Medical Center, Shanghai, China
| | | |
Collapse
|
73
|
Jatia S, Prasad M, Paradkar A, Bhatia A, Narula G, Chinnaswamy G, Vora T, Gomle S, Sankaran H, Banavali S. Holistic support coupled with prospective tracking reduces abandonment in childhood cancers: A report from India. Pediatr Blood Cancer 2019; 66:e27716. [PMID: 30900819 DOI: 10.1002/pbc.27716] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND High cure rates of over 80% in childhood cancers reported from high-income countries (HICs) are not replicated in low- and middle-income countries (LMICs). Treatment abandonment (TxA) is an important reason for this poorer outcome. We assessed the effect of a holistic support group approach coupled with prospective tracking on TxA in children with cancer in a limited-resources environment. METHODS In 2010, all existing nongovernmental organizations (NGOs) working with childhood cancer at our hospital were brought together to form a pediatric cancer foundation with the aim of providing holistic support to the patient and family, including financial, psychosocial, lodging, educational, and bereavement support. Simultaneously, prospective tracking of all children with a Time-Responsive Electronic Abandonment Tracking (TREAT) system was also established. The impact of these measures on TxA over the 2009-2016 period was compared using the log-rank test. RESULTS The annual rate of abandonment reduced from 20% in 2009 to 10.4% in 2010 and 5.2% in 2011. It has been consistently between 3% and 6% from 2012 to 2016 (P -0.04). TxA after the initiation of treatment dropped from 9% in 2009 to 1% in 2016 (P -0.02), while refusal to initiate treatment dropped from 11% to 2.7% (P -0.23) over the same period. CONCLUSIONS A holistic support group consisting of the hospital team, as well as existing NGOs and governmental organizations, along with a systematic and prospective tracking system significantly reduced abandonment in a resource-constrained setting. This cost-effective holistic support group may be applicable in other LMICs with similar healthcare systems.
Collapse
Affiliation(s)
- Shalini Jatia
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Amey Paradkar
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Ameeta Bhatia
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Tushar Vora
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sanjay Gomle
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Hari Sankaran
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
74
|
Hazarika M, Mishra R, Saikia BJ, Bhuyan C, Nyuthe CW, Sarma A, Kumar G, Sutnaga C, Kalita M, Roy P. Causes of Treatment Abandonment of Pediatric Cancer
Patients – Experience in a Regional Cancer Centre in North
East India. Asian Pac J Cancer Prev 2019; 20:1133-1137. [PMID: 31030486 PMCID: PMC6948912 DOI: 10.31557/apjcp.2019.20.4.1133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Refusal and abandonment of treatment is often considered as an important reason for poor survival of pediatric cancer patients in developing and underdeveloped countries. In this study we analyze the factors responsible for treatment abandonment and refusal in a Regional Cancer Centre (RCC) in North East India. Material and Methods: All histopathologically or cytologically confirmed cases of childhood cancer from below 15 years of age registered from 1st April, 2010 to 31st March, 2017 were included in this study. Parents or caregivers were interviewed thoroughly and a questionnaire was filled up for analysis of demographic and socio-economic factors. Modified Kuppuswamy scale was used to measure socioeconomic status. Results: Of 592 patients 161 (27.1%) abandoned therapy and 23 (3.9%) refused treatment. Factors associated with abandonment of treatment included: lower risk if residing in urban areas (Odds ratio [OR] = 0.8333, 95% CI 0.565-1.228; P=0.36) and higher risk with maternal education less than secondary school (OR = 1.357; 95%CI: 0.553-3.326; P=0.505). Low socioeconomic status and age >5yrs were also associated with abandonment of treatment. In a binary logistic regression analysis, male sex [Odds Ratio (OR) = 0.701; 95% CI 0.48-1.01; P=0.062] have lowest risk of abandoning treatment with trend to statistical significance. Conclusion: There is a need for proper definition of the problem of childhood cancer patients so that appropriate policy can be introduced to improve survival by improving treatment compliance.
Collapse
Affiliation(s)
- Munlima Hazarika
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Rakesh Mishra
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Bhargab Jyoti Saikia
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Chidananda Bhuyan
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - C W Nyuthe
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Anupam Sarma
- Department of Pathology, Dr. B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India
| | - Gaurav Kumar
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Cliffton Sutnaga
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Manoj Kalita
- Population Based Cancer Registry, National Cancer Registry Programme (ICMR), Dr. B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India
| | - Partha Roy
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| |
Collapse
|
75
|
Eden T, Burns E, Freccero P, Renner L, Paintsil V, Dolendo M, Scanlan T, Khaing AA, Pina M, Islam A, Chunda-Liyoka C, Kouya F, Molyneux E. Are essential medicines available, reliable and affordable in low-middle income countries? J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2018.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
76
|
Ortega-García JA, Tellerías L, Ferrís-Tortajada J, Boldo E, Campillo-López F, van den Hazel P, Cortes-Arancibia S, Ramis R, Gaioli M, Monroy-Torres R, Farias-Guardia C, Borras M, Yohannessen K, García-Noriega-Fernández M, Cárceles-Álvarez A, Jaimes-Vega DC, Cordero-Rizo M, López-Hernández F, Claudio L. Threats, challenges and opportunities for paediatric environmental health in Europe, Latin America and the Caribbean. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
77
|
Ortega-García JA, Tellerías L, Ferrís-Tortajada J, Boldo E, Campillo-López F, van den Hazel P, Cortes-Arancibia S, Ramis R, Gaioli M, Monroy-Torres R, Farias-Guardia C, Borras M, Yohannessen K, García-Noriega-Fernández M, Cárceles-Álvarez A, Jaimes-Vega DC, Cordero-Rizo M, López-Hernández F, Claudio L. Amenazas, desafíos y oportunidades para la salud medioambiental pediátrica en Europa, América Latina y el Caribe. An Pediatr (Barc) 2019; 90:124.e1-124.e11. [DOI: 10.1016/j.anpedi.2018.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 02/01/2023] Open
|
78
|
Rahman SA, Otim ME, Almarzouqi A, Rahman S. Setting Priorities in Childhood Cancer in Low Income Countries Using Nominal Group Technique: Experience from an International Childhood Cancer Forum Exercise in Bangladesh. Asian Pac J Cancer Prev 2019; 20:97-103. [PMID: 30678387 PMCID: PMC6485563 DOI: 10.31557/apjcp.2019.20.1.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Cancer is one of the major causes of mortality and morbidity worldwide. The incidence of paediatric cancer in particular, in Bangladesh is alarming and most of these patients die without correct diagnosis and adequate medical treatment (MOHFW, 2008). There is a clear disparity in access to care between rural and urban areas (WHO, 2015; Rahman, 2001). There are no established formal childhood cancer registry systems to help inform planning decisions across the country. Most importantly, there are no explicit priorities or methods for identifying such priorities in Low and Middle Income Countries (LMICs). We used a Nominal Group Technique (NGT) method during the International Childhood Cancer Forum (ICCF) for setting priorities. The following two key objectives were addressed: Trialling the NGT in Bangladesh as a priority setting tool; and identify childhood cancer priorities in Bangladesh. Methods: The Nominal Group Techniques (NGT) method was used to elicit information from the participants of ICCF to identify priorities for research and interventions for childhood cancer care in Bangladesh. Participants were divided into four groups. Each group discussed one question each. Two questions focused on cancer research, and the other two focused on interventions. Results: In regards to outcomes, NGT successfully identified the scale of childhood cancer care and identified priorities/action areas to address in Bangladesh. Six priorities were identified and a successful collaboration for implementation has been established with several international organisations. Conclusion: Nominal group technique was found to be an effective tool to identify research and intervention priorities to address childhood cancer in a developing country. For resource limited countries in similar situations, they could benefit from adopting this approach in healthcare settings.
Collapse
Affiliation(s)
- Syed Azizur Rahman
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Prime University, Bangladesh.
| | | | | | | |
Collapse
|
79
|
Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, Steliarova-Foucher E, Frazier AL, Robison LL, Rodriguez-Galindo C, Fitzmaurice C. Childhood cancer burden: a review of global estimates. Lancet Oncol 2019; 20:e42-e53. [PMID: 30614477 DOI: 10.1016/s1470-2045(18)30761-7] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022]
Abstract
5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents.
Collapse
Affiliation(s)
- Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Lisa M Force
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rifat Atun
- Harvard T H Chan School of Public Health and Harvard Medical School, Harvard University, Boston, MA, USA
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Christina Fitzmaurice
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| |
Collapse
|
80
|
Kutluk T, Ataş E, Gültekin M, Torode J, Sullivan R. Cancer control in member countries of Organization of Islamic Cooperation (OIC)—A status report & İstanbul declaration by the first ladies of OIC. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
81
|
Pediatric oncology-hematology outreach: Evaluation of patient consultations by teleconferences between Indonesian and Dutch academic hospitals. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
82
|
Narula G, Prasad M, Jatia S, Subramanian PG, Patkar N, Tembhare P, Shetty D, Khanna N, Laskar S, Shet T, Epari S, Kembhavi S, Shah S, Qureshi S, Gujral S, Banavali SD. Clinicoepidemiological profiles, clinical practices, and the impact of holistic care interventions on outcomes of pediatric hematolymphoid malignancies - A 7-year audit of the pediatric hematolymphoid disease management group at Tata Memorial Hospital. Indian J Cancer 2018; 54:609-615. [PMID: 30082544 DOI: 10.4103/ijc.ijc_487_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Pediatric Hematolymphoid Disease Management Group (PHL-DMG) at a tertiary cancer care hospital developed extensive patient support programs to improve retention and outcomes while focusing on protocols adapted to meet patient needs. An audit of measures and outcomes was done for a 7-year period from January 2010 to December 2016. MATERIALS AND METHODS DMG protocols and patient support activities over the study period were documented and audited. Data was retrieved from internal databases and records. Measures taken and their impact were assessed by descriptive analytical tools. Survival outcomes were calculated using Kaplan-Meier method on SPSS v. 24™ software. RESULTS Holistic patient support measures were undertaken through a charitable foundation entirely under pediatric oncology. Activities included infrastructure growth, socioeconomic support, provision of accommodation, nutrition, education, and multiple blood component donation drives. Patient registrations increased from 502 in 2009 to 874 in 2016, with the steepest rise in acute lymphoblastic leukemia (ALL) - 330 (2009) to 547 (2016). Treatment refusal and abandonment rates decreased from 32% to 3.4% over the same period, and male to female ratio decreased from 2.56 to 2.28:1. Early mortality in acute myeloid leukemia (AML) fell within 2 years from 26.7% in 2009 to 7%. Five-year overall survival (OS) was 69.5% for all patients registered in 2010, whereas disease-specific 5-year OS was ALL 67.1%, AML 49.3%, chronic myeloid leukemia 100%, Hodgkin lymphoma 90.4%, and non-Hodgkin lymphoma 74.2%. CONCLUSIONS Holistic patient support-specific activities and adapted protocols made a measurable impact on patient outcomes. High survival outcomes of patients have been achieved despite relatively few receiving salvage therapies or stem cell transplant.
Collapse
Affiliation(s)
- Gaurav Narula
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shalini Jatia
- ImPaCCT Foundation of Pediatric Oncology Division, Mumbai, Maharashtra, India
| | | | - Nikhil Patkar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dhanlaxmi Shetty
- Department of Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
83
|
Schroeder K, Saxton A, McDade J, Chao C, Masalu N, Chao C, Wechsler DS, Likonda B, Chao N. Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes. J Glob Oncol 2018; 4:1-10. [PMID: 30241177 PMCID: PMC6180837 DOI: 10.1200/jgo.2016.009027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The majority of new diagnoses of pediatric cancer are made in resource-poor countries, where survival rates range from 5% to 25% compared with 80% in high-resource countries. Multiple factors, including diagnostic and treatment capacities and complex socioeconomic factors, contribute to this variation. This study evaluated the available resources and outcomes for pediatric patients with cancer at the first oncology treatment center in northern Tanzania. METHODS Qualitative interviews were completed from July to August 2015 to determine available staff, hospital, diagnostic, treatment, and supportive care resources. A retrospective review of hospital admissions and clinic visits from January 2010 to August 2014 was completed. A total of 298 patients were identified, and data from 182 patient files were included in this review. RESULTS Diagnostic, treatment, and supportive capacities are limited for pediatric cancer care. The most common diagnoses were Burkitt lymphoma (n = 32), other non-Hodgkin lymphoma (n = 26), and Wilms tumor (n = 25). A total of 40% of patients (n = 72) abandoned care. There was a 20% 2-year event-free survival rate, which was significantly affected by patient age, method of diagnosis, and year of diagnosis. CONCLUSION To our knowledge, this is the first review of pediatric cancer outcomes in northern Tanzania. The study identified areas for future development to improve pediatric cancer outcomes, which included strengthening of training and diagnostic capacities, development of registries and research databases, and the need for additional research to reduce treatment abandonment.
Collapse
Affiliation(s)
- Kristin Schroeder
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Anthony Saxton
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Jessica McDade
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Christina Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nestory Masalu
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Colin Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Daniel S Wechsler
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Beda Likonda
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nelson Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| |
Collapse
|
84
|
Joko-Fru WY, Parkin DM, Borok M, Chokunonga E, Korir A, Nambooze S, Wabinga H, Liu B, Stefan C. Survival from childhood cancers in Eastern Africa: A population-based registry study. Int J Cancer 2018; 143:2409-2415. [PMID: 29981149 DOI: 10.1002/ijc.31723] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 11/05/2022]
Abstract
Cancers occurring in children in Africa are often underdiagnosed, or at best diagnosed late. As a result, survival is poor, even for cancers considered 'curable'. With limited population-level data, understanding the actual burden and survival from childhood cancers in Africa is difficult. In this study, we aimed at providing survival estimates for the most common types of cancers affecting children aged 0-14 years, in three population-based Eastern African registries; Harare, Zimbabwe (Kaposi sarcoma, Wilms tumour (WT), non-Hodgkin lymphoma (NHL), retinoblastoma, and acute lymphocytic leukaemia (ALL)), Kampala, Uganda (Burkitt lymphoma, Kaposi sarcoma, WT, and retinoblastoma), and Nairobi, Kenya (ALL, retinoblastoma, WT, Burkitt lymphoma, and Hodgkin lymphoma). We included cases diagnosed within the years 1998-2009 and followed up till the end of 2011. We estimated the observed and relative survival at 1, 3, and 5 years after diagnosis. We studied 627 individual patient records. Median follow-up ranged from 2.2 months for children with Kaposi sarcoma in Harare to 30.2 months for children with ALL in Nairobi. The proportion of children lost to follow-up was highest in the first year after diagnosis. In Harare and Kampala, the 5-year relative survival was <46% for all cancer types. The 5-year relative survival was best for children in Nairobi, though with wider confidence intervals. Survival from childhood cancers in Africa is still poor, even for cancers with good prognosis and potential for cure. Supporting cancer detection, treatment, and registration activities could help improve survival chances for children with cancers in Africa.
Collapse
Affiliation(s)
- W Yvonne Joko-Fru
- The African Cancer Registry Network, INCTR African Registry Programme, Nuffield Department of Population Health, University of Oxford, Oxford, OX2 7HT, United Kingdom
| | - D Maxwell Parkin
- The African Cancer Registry Network, INCTR African Registry Programme, Nuffield Department of Population Health, University of Oxford, Oxford, OX2 7HT, United Kingdom
| | - Margaret Borok
- Zimbabwe National Cancer Registry, P.O. Box A449, Avondale, Harare, Zimbabwe
| | - Eric Chokunonga
- Zimbabwe National Cancer Registry, P.O. Box A449, Avondale, Harare, Zimbabwe
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Nambooze
- Kampala cancer Registry, Kampala Cancer Registry, Department of Pathology - College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Kampala cancer Registry, Kampala Cancer Registry, Department of Pathology - College of Health Sciences, Makerere University, Kampala, Uganda
| | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Programme, Nuffield Department of Population Health, University of Oxford, Oxford, OX2 7HT, United Kingdom
| | - Cristina Stefan
- AORTIC, 37A Main Road, Mowbray, Cape Town, 7705, South Africa
| |
Collapse
|
85
|
Micho H, Mohammed Y, Hailu D, Genet S. Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC HEMATOLOGY 2018; 18:22. [PMID: 30186610 PMCID: PMC6122136 DOI: 10.1186/s12878-018-0117-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/20/2018] [Indexed: 11/23/2022]
Abstract
Background Tumor lysis syndrome (TLS) is a life-threatening emergency disorder, caused by an abrupt release of intracellular metabolites after tumor cell death. It is characterized by a series of metabolic manifestations, especially hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. The aim of this study was to evaluate and characterize the incidence of tumor lysis syndrome among pediatric oncology patients before and after treatment. Methods Hospital based prospective cohort study was conducted for 6 months on 61 newly diagnosed pediatric oncology patients. Socio-demographic data was collected by interview administered questionnaire. Patients were followed and the physical diagnosis, imaging and laboratory results were interpreted by senior physicians. Data was entered to and analyzed by SPSS version 23. Results Among 61 pediatric oncology patients 39(63.9%) were males. The mean (±SD) age of the pediatric patients was 6.39 (± 3.67) years ranging from 2 months to 14 years. 29.5% of patients were found to have TLS. There were 11.5% and 18.0% of laboratory TLS (LTLS) and clinical TLS (CTLS) cases respectively. There were72.2% spontaneous and 27.8% treatment induced TLS cases with 23% and 21.3% cases of hyperuricemia and 4.9% and 6.6% cases of hyperkalemia incidence before and after treatment respectively. Only two patients died, in the study period, due to TLS. Conclusion There was high incidence of TLS irrespective of socio-demographic variation among study participants, suggesting that children with cancer are at risk of developing TLS. As TLS is a life-threatening complication of malignancies, early identification of patients at risk and reducing morbidity and mortality is crucially important.
Collapse
Affiliation(s)
- Haileleul Micho
- 1Department of Biomedical Sciences, College of Health Sciences, Dilla University, Dilla, Ethiopia.,2Department of Medical Biochemistry, School of Medicine, College of Health sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| | - Yasin Mohammed
- 3Department of Pediatrics and child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Hailu
- 3Department of Pediatrics and child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Genet
- 2Department of Medical Biochemistry, School of Medicine, College of Health sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| |
Collapse
|
86
|
Al-Asadi JN, Ibrahim SJ. Childhood Cancer in Basrah, Iraq During 2012-2016: Incidence and Mortality. Asian Pac J Cancer Prev 2018; 19:2337-2341. [PMID: 30141312 PMCID: PMC6171401 DOI: 10.22034/apjcp.2018.19.8.2337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/26/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Worldwide, childhood cancer is rare. In addition, a distinct variation in both incidence and type distribution was reported between countries. Aim: To estimate the incidence and mortality rates of childhood cancer in Basrah, Iraq during 2012-2016. Methods: This registry based descriptive study included children aged 0-14 years with primary cancer who were newly diagnosed in Basrah during 2012-2016. The types of malignant tumors were classified according to International Classification of Childhood Cancer, Version 3 (ICCC-3). The overall and specific incidence and mortality rates by age and sex were calculated per 100,000 population. Results: A total of 723 new cases of childhood cancer were registered during the five- year study period, with a male to-female ratio of 1.2/1. Children aged <4 years accounted for 43.1% of patients. The overall incidence rate was 13.74/100,000, and the age standardized incidence rate (ASIR) was 13.87/100,000. Boys showed higher incidence rate than girls (14.78 vs. 12.66/100,000). Leukemia was the most common type of childhood cancer accounting for 35.4%, followed by lymphoma (17.8%), and central nervous system tumors 11.9%. The overall cancer-specific mortality rate was 6.04/100,000 and the ASMR was 6.08/100,000 children. Conclusion: The incidence rate of childhood cancer in Basrah as well as the cancer type distribution was comparable to that reported for developing countries.
Collapse
Affiliation(s)
- Jasim N Al-Asadi
- Department of Family and Community Medicine, College of Medicine, Basrah University, Basrah, Iraq.
| | | |
Collapse
|
87
|
Vasquez L, Diaz R, Chavez S, Tarrillo F, Maza I, Hernandez E, Oscanoa M, García J, Geronimo J, Rossell N. Factors associated with abandonment of therapy by children diagnosed with solid tumors in Peru. Pediatr Blood Cancer 2018; 65:e27007. [PMID: 29431252 DOI: 10.1002/pbc.27007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. METHODS We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. RESULTS Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. CONCLUSION Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results.
Collapse
Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Rosdali Diaz
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sharon Chavez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Fanny Tarrillo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Eddy Hernandez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Monica Oscanoa
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Juan García
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jenny Geronimo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Nuria Rossell
- Amsterdam Institute for Social Sciences Research, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
88
|
|
89
|
Crnogorac S, Miranovic V. Pregnancy after malignant disease - challenges and possibilities. J Perinat Med 2018; 46:349-353. [PMID: 29055175 DOI: 10.1515/jpm-2017-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Snezana Crnogorac
- Clinic Centre of Montenegro - Clinic for Obstetrics and Gynecology, Podgorica, Montenegro
| | - Vesna Miranovic
- Clinic Centre of Montenegro - Institute for Child Disease, Podgorica, Montenegro
| |
Collapse
|
90
|
Walubita M, Sikateyo B, Zulu JM. Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia. BMC Health Serv Res 2018; 18:314. [PMID: 29720168 PMCID: PMC5932785 DOI: 10.1186/s12913-018-3127-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. METHODS This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. RESULTS Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. CONCLUSION Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.
Collapse
Affiliation(s)
- Mulima Walubita
- School of Public Health, Department of Health Promotion and Education, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
| | - Bornwell Sikateyo
- School of Public Health, Department of Health Promotion and Education, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Joseph M Zulu
- School of Public Health, Department of Health Promotion and Education, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| |
Collapse
|
91
|
Howard SC, Zaidi A, Cao X, Weil O, Bey P, Patte C, Samudio A, Haddad L, Lam CG, Moreira C, Pereira A, Harif M, Hessissen L, Choudhury S, Fu L, Caniza MA, Lecciones J, Traore F, Ribeiro RC, Gagnepain-Lacheteau A. The My Child Matters programme: effect of public–private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol 2018; 19:e252-e266. [DOI: 10.1016/s1470-2045(18)30123-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 12/18/2022]
|
92
|
Fedorovsky JM, Cuervo LG, Luciani S. Pediatric cancer registries in Latin America: the case of Argentina's pediatric cancer registry. Rev Panam Salud Publica 2017; 41:e152. [PMID: 31384271 PMCID: PMC6645297 DOI: 10.26633/rpsp.2017.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/22/2017] [Indexed: 01/03/2023] Open
Abstract
Despite its low incidence, pediatric cancer makes up a significant portion of childhood illnesses. Yet information on pediatric cancer in Latin America is scarce. Since the early 2000s the World Health Organization (WHO) has been highlighting the role of cancer registries in cancer surveillance and control. This article describes the main aspects of pediatric cancer registration in Latin America, highlighting the successes of Argentina's national pediatric cancer registry, Registro Oncopediátrico Hospitalario Argentino (ROHA), which allows for better health care and contributes to improved outcomes for children with cancer, to provide a rationale for the expansion and enhancement of pediatric cancer registration in other Latin American countries.
Collapse
Affiliation(s)
- Johanna Michelle Fedorovsky
- American University American University Washington, D.C. United States of America American University, Washington, D.C., United States of America
| | - Luis Gabriel Cuervo
- Pan American Health Organization Pan American Health Organization Washington, D.C United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- American University American University Washington, D.C. United States of America American University, Washington, D.C., United States of America
| |
Collapse
|
93
|
Karalexi MA, Georgakis MK, Dessypris N, Ryzhov A, Zborovskaya A, Dimitrova N, Zivkovic S, Eser S, Antunes L, Sekerija M, Zagar T, Bastos J, Demetriou A, Agius D, Florea M, Coza D, Bouka E, Dana H, Hatzipantelis E, Kourti M, Moschovi M, Polychronopoulou S, Stiakaki E, Pourtsidis A, Petridou ET. Mortality and survival patterns of childhood lymphomas: geographic and age-specific patterns in Southern-Eastern European and SEER/US registration data. Hematol Oncol 2017; 35:608-618. [PMID: 27641612 DOI: 10.1002/hon.2347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 09/15/2023]
Abstract
Childhood (0-14 years) lymphomas, nowadays, present a highly curable malignancy compared with other types of cancer. We used readily available cancer registration data to assess mortality and survival disparities among children residing in Southern-Eastern European (SEE) countries and those in the United States. Average age-standardized mortality rates and time trends of Hodgkin (HL) and non-Hodgkin (NHL; including Burkitt [BL]) lymphomas in 14 SEE cancer registries (1990-2014) and the Surveillance, Epidemiology, and End Results Program (SEER, United States; 1990-2012) were calculated. Survival patterns in a total of 8918 cases distinguishing also BL were assessed through Kaplan-Meier curves and multivariate Cox regression models. Variable, rather decreasing, mortality trends were noted among SEE. Rates were overall higher than that in SEER (1.02/106 ), which presented a sizeable (-4.8%, P = .0001) annual change. Additionally, remarkable survival improvements were manifested in SEER (10 years: 96%, 86%, and 90% for HL, NHL, and BL, respectively), whereas diverse, still lower, rates were noted in SEE. Non-HL was associated with a poorer outcome and an amphi-directional age-specific pattern; specifically, prognosis was inferior in children younger than 5 years than in those who are 10 to 14 years old from SEE (hazard ratio 1.58, 95% confidence interval 1.28-1.96) and superior in children who are 5 to 9 years old from SEER/United States (hazard ratio 0.63, 95% confidence interval 0.46-0.88) than in those who are 10 to 14 years old. In conclusion, higher SEE lymphoma mortality rates than those in SEER, but overall decreasing trends, were found. Despite significant survival gains among developed countries, there are still substantial geographic, disease subtype-specific, and age-specific outcome disparities pointing to persisting gaps in the implementation of new treatment modalities and indicating further research needs.
Collapse
Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine
| | - Anna Zborovskaya
- Childhood Cancer Sub-registry of Belarus, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | | | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Izmir, Turkey
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian National Institute of Public Health, Zagreb, Croatia
| | - Tina Zagar
- Cancer Registry of Republic of Slovenia, Institute of Oncology, Ljubljana, Slovenia
| | - Joana Bastos
- Central Region Cancer Registry of Portugal (ROR-Centro), Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Anna Demetriou
- Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Department of Health Information and Research, Malta National Cancer Registry, Pieta, Malta
| | - Margareta Florea
- Regional Cancer Registry of Iasi, National Institute of Public Health, Iasi, Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Cluj-Napoca, Romania
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Helen Dana
- Oncology Department, "Mitera" Children's Hospital, Athens, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotelian University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| |
Collapse
|
94
|
Mueller EL, Hall M, Berry JG, Carroll AE, Macy ML. Healthcare utilization and spending by children with cancer on Medicaid. Pediatr Blood Cancer 2017; 64. [PMID: 28417587 DOI: 10.1002/pbc.26569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for care optimization. PROCEDURE We performed a retrospective, cross-sectional analysis of the 2014 Truven Marketscan Medicaid Database to explore clinical attributes, utilization, and spending among children with cancer who were Medicaid enrollees. Eligible patients included children (ages 0-18 years) with cancer (Clinical Risk Group 8). Healthcare utilization and spending (per member per month, PMPM) were assessed overall and across specific healthcare services. RESULTS Children with cancer (n = 5,405) represent less than 1% of the 1,516,457 children with medical complexity in the dataset. Children with cancer had high services use: laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), outpatient therapy/treatment (53.4%), emergency department (43.7%), hospitalization (31.5%), home healthcare (9.5%). PMPM spending for children with cancer was $3,706 overall and $2,323 for hospital care. CONCLUSION Children with cancer have high healthcare resource use and spending. Differences in geographic distribution of services for children with cancer and the trajectory of spending over the course of therapy are areas for future investigation aimed at lowering costs of care without compromising on health outcomes.
Collapse
Affiliation(s)
- Emily L Mueller
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana.,Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana
| | - Matt Hall
- Division of Analytics, Children's Hospital Association, Overland Park, Kansas
| | - Jay G Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana
| | - Michelle L Macy
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
95
|
Pramanik R, Agarwala S, Gupta YK, Thulkar S, Vishnubhatla S, Batra A, Dhawan D, Bakhshi S. Metronomic Chemotherapy vs Best Supportive Care in Progressive Pediatric Solid Malignant Tumors: A Randomized Clinical Trial. JAMA Oncol 2017; 3:1222-1227. [PMID: 28384657 DOI: 10.1001/jamaoncol.2017.0324] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although oral metronomic chemotherapy is often used in progressive pediatric solid malignant tumors, a literature review reveals that only small single-arm retrospective or phase 1 and 2 studies have been performed. Skepticism abounds because of the lack of level 1 evidence. Objectives To compare the effect of metronomic chemotherapy on progression-free survival (PFS) with that of placebo in pediatric patients with primary extracranial, nonhematopoietic solid malignant tumors that progress after at least 2 lines of chemotherapy. Design, Setting, and Participants A double-blinded, placebo-controlled randomized clinical trial was conducted from October 1, 2013, through December 31, 2015, at the cancer center at All India Institute of Medical Sciences in children aged 5 to 18 years with primary extracranial, nonhematopoietic solid malignant tumors that progressed after at least 2 lines of chemotherapy and had no further curative options. Interventions One arm received a 4-drug oral metronomic regimen of daily celecoxib and thalidomide with alternating periods of etoposide and cyclophosphamide, whereas the other arm received placebo. Disease status was assessed at baseline, 9 weeks, 18 weeks, and 27 weeks or at clinical progression. Main Outcomes and Measures The primary end point was PFS as defined by the proportion of patients without disease progression at 6 months, and PFS duration and overall survival (OS) were secondary end points. Results A total of 108 of the 123 patients screened were enrolled, with 52 randomized to the placebo group (median age, 15 years; 40 male [76.9%]) and 56 to the metronomic chemotherapy group (median age, 13 years; 42 male [75.0%]). At a median follow-up of 2.9 months, 100% of the patients had disease progression by 6 months in the placebo group vs 96.4% in the metronomic chemotherapy group (P = .24). Median PFS and OS in the 2 groups was similar (hazard ratio [HR], 0.69; 95% CI, 0.47-1.03 [P = .07] for PFS; and HR, 0.74; 95% CI, 0.50-1.09 [P = .13] for OS). In post hoc subgroup analysis, cohorts receiving more than 3 cycles (HR for PFS, 0.46; 95% CI, 0.23-0.93; P = .03) and those without a bone sarcoma (ie, neither primitive neuroectodermal tumor nor osteosarcoma) (HR for PFS, 0.39; 95% CI, 0.18-0.81; P = .01) appeared to benefit from metronomic chemotherapy. Conclusions and Relevance Metronomic chemotherapy does not improve 6-month PFS, compared with placebo, among pediatric patients with extracranial progressive solid malignant tumors . However, patients without bone sarcoma and those able to tolerate therapy for more than 3 cycles (9 weeks) benefit. Trial Registration clinicaltrials.gov Identifier: NCT01858571.
Collapse
Affiliation(s)
- Raja Pramanik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Atul Batra
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dhawan
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
96
|
Ceppi F, Beck-Popovic M, Bourquin JP, Renella R. Opportunities and challenges in the immunological therapy of pediatric malignancy: a concise snapshot. Eur J Pediatr 2017; 176:1163-1172. [PMID: 28803259 DOI: 10.1007/s00431-017-2982-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 12/18/2022]
Abstract
Over the last 50 years, collaborative clinical trials have reduced the number of children dying from pediatric cancer significantly. Unfortunately, certain tumor types have remained resistant to conventional surgical, radiotherapy and chemotherapy combinations, and relapsing and/or refractory disease remains associated with dismal outcomes. Recently, renewed attention has been given to the role for immunotherapies in pediatric oncology. In fact, these combine several attractive features, including (but possibly not limited to) the specificity for cancer cells, potentially in vivo persistence and longevity, and potency against refractory disease. In this narrative review designed for the academic pediatrician, we will concisely review the biological underpinnings behind the immunological therapy of pediatric neoplasms and illustrate the current humoral, cellular approaches, and novel drugs targeting the immune checkpoint, oncolytic viruses, and tumor vaccines. We will also comment on the future directions, challenges, and open questions faced by the field. What is Known: • Cancer immunotherapy drives immune cells and its humoral weaponry to eliminate tumor cells. • This occurs by recognizing antigens ideally expressed only on tumoral, but not normal/healthy, cells. What is New: • Clinical immunotherapy trials have shown responses in children with relapsing/refractory neoplasms. • Novel humoral/cellular immunotherapies, immune checkpoint inhibitors, oncolytic viruses, and tumor vaccines are currently being investigated in pediatric oncology.
Collapse
Affiliation(s)
- Francesco Ceppi
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Bourquin
- Leukemia Research Program and Division of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raffaele Renella
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
97
|
Parkin DM, Stefan C. Editorial: Childhood Cancer in sub-Saharan Africa. Ecancermedicalscience 2017; 11:ed69. [PMID: 28798814 PMCID: PMC5533598 DOI: 10.3332/ecancer.2017.ed69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 02/02/2023] Open
Abstract
Measurement of incidence rates of childhood cancer in Africa is difficult. The study 'Cancer of Childhood in sub Saharan Africa' [Stefan C, Bray F, Ferlay J, Parkin DM and Liu B (2017) Cancer of Childhood in sub-Saharan Africaecancer11(755)] brings together results from 16 population-based registries which, as members of the African Cancer Registry Network (AFCRN), have been evaluated as achieving adequate coverage of their target population. The cancers are classified according to the third revision of the International Classification of Childhood Cancer (ICCC-3) and recorded rates in Africa are compared with those in childhood populations in the UK, France, and the USA. It is clear that, in many centres, lack of adequate diagnostic and treatment facilities, leads to under-diagnosis (and enumeration) of leukaemias and brain cancers. However, for several childhood cancers, incidence rates in Africa are higher than those in high income countries. This applies to infection-related cancers such as Kaposi sarcoma, Burkitt lymphoma, Hodgkin lymphoma and hepatocellular carcinoma, and also to two common embryonal cancers-retinoblastoma and nephroblastoma. These (and other) observations are unlikely to be artefact, and are of considerable interest when considering possible aetiological factors, including ethnic differences in risk (and hence genetic/familial antecedents). The data reported are the most extensive so far available on the incidence of cancer in sub Saharan Africa, and clearly indicate the need for more resources to be devoted to cancer registration, especially in the childhood age range, as part of an overall programme to improve the availability of diagnosis and treatment of this group of cancers, many of which have-potentially-an excellent prognosis.
Collapse
Affiliation(s)
- Donald Maxwell Parkin
- African Cancer Registry Network, INCTR, Prama House, 267 Banbury Road, Oxford OX2 7HT, United Kingdom
- CTSU, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Cristina Stefan
- Medical Research Council, PO Box 19070, Tygerberg 7505, Republic of South Africa
| |
Collapse
|
98
|
Rivera-Luna R, Zapata-Tarres M, Shalkow-Klincovstein J, Velasco-Hidalgo L, Olaya-Vargas A, Finkelstein-Mizrahi N, Cárdenas-Cardós R, Aguilar-Ortiz MR. The burden of childhood cancer in Mexico: Implications for low- and middle-income countries. Pediatr Blood Cancer 2017; 64. [PMID: 27905680 DOI: 10.1002/pbc.26366] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/03/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022]
Abstract
In Mexico, childhood cancer incidence and mortality have increased in the last decade. Through government actions since 2005, the Popular Medical Insurance (PMI) program for childhood cancer was created. The objective of PMI was to offer early cancer diagnosis, standardized treatment regimens, and numerous pediatric oncology residency programs. It has also accredited 55 national hospitals for the care of these children. Current problems still present under the PMI include shortage of pediatric oncologists and nurses and high rate of abandonment of treatment. Our aim is to describe the current scenario of childhood cancer care in Mexico, especially from the perspective of the PMI and how it has impacted human resources, infrastructure, and medical education.
Collapse
Affiliation(s)
- Roberto Rivera-Luna
- Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico.,Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Marta Zapata-Tarres
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Jaime Shalkow-Klincovstein
- Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Liliana Velasco-Hidalgo
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Alberto Olaya-Vargas
- Bone Marrow Transplant Unit, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Nicole Finkelstein-Mizrahi
- General Direction of Development of Health Services, Office of the Fund for Protection Against Catastrophic Expenses for Childhood Cancer from the Popular Medical Insurance, Mexico City, Mexico
| | - Rocío Cárdenas-Cardós
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Marco R Aguilar-Ortiz
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| |
Collapse
|
99
|
|
100
|
Rivera-Luna R, Velasco-Hidalgo L, Zapata-Tarrés M, Cárdenas-Cardos R, Aguilar-Ortiz MR. Current outlook of childhood cancer epidemiology in a middle-income country under a public health insurance program. Pediatr Hematol Oncol 2017; 34:43-50. [PMID: 28287336 DOI: 10.1080/08880018.2016.1276236] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Mexico, childhood cancer (0-18 years) is treated in a multidisciplinary way while providing care for more than half of the affected children through a public medical insurance. This insurance is given to all children who do not have any health care coverage in Mexico. This program is offered to the poorest of all Mexicans. All the children with this disease are submitted to pathology diagnosis and treatment according to national treatment protocols from 57 accredited medical institutions. From 2007 to 2015, a total of 24,039 children with cancer have been registered; the male gender predominates by 55%. The highest incidence was in the group aged between 0 and 4 years. Every year, there has been an increment in registration. In 2015, there were 3,433 new patients with an incidence of 150.1/million. In the same year, the incidence for all types of leukemia increased to 89.5/million. But for acute lymphoblastic leukemia, the incidence was found to be 79.8/million, which is extremely high. The mortality rate for all these patients in 2015 was 5.3/100,000. However, with regard to children aged between 15 and 18 years, the mortality rate was 8.5/100,000. Abandonment rate was 10%, and there were nine state institutions that had a mortality rate between 25% and 50% among their patients. Coincidentally, as per the Human Development Index, the parameters for education, health, and income were low for those nine institutions. The purpose of this work is to show the epidemiology and the burden we are facing due to this disease.
Collapse
Affiliation(s)
- Roberto Rivera-Luna
- a Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer/Department of Pediatric Oncology , UNAM/Division of Pediatric Hematology/Oncology, National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Liliana Velasco-Hidalgo
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Marta Zapata-Tarrés
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Rocío Cárdenas-Cardos
- c Department of Pediatric Oncology, UNAM/Department of Oncology , National Institute of Pediatrics (NIP)/Program of the National Council for the Prevention and Treatment of Childhood Cancer , Mexico City , Mexico
| | - Marco R Aguilar-Ortiz
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| |
Collapse
|