1
|
Businge L, Hagenimana M, Motlhale M, Bardot A, Liu B, Anastos K, Castle PE, Murenzi G, Claire K, Sabushimike D, Cyuzuzo C, Kubwimana G, Maniragaba T, Uwinkindi F, Paczkowski M, Soerjomataram I, Parkin DM. Stage at diagnosis and survival by stage for the leading childhood cancers in Rwanda. Pediatr Blood Cancer 2024; 71:e31020. [PMID: 38668553 PMCID: PMC11116036 DOI: 10.1002/pbc.31020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. METHODS In this study, data from the Rwanda National Cancer Registry (RNCR) were examined for children aged 0-14 diagnosed in 2013-2017 for the eight most commonly occurring childhood cancers: acute lymphoblastic leukaemia, Hodgkin lymphoma (HL), Burkitt lymphoma (BL), non-Hodgkin lymphoma excluding BL, retinoblastoma, Wilms tumour, osteosarcoma and rhabdomyosarcoma. Utilising the Toronto Childhood Cancer Stage Guidelines Tier 1, the study assigned stage at diagnosis to all, except HL, and conducted active follow-ups to calculate 1-, 3- and 5-year observed and relative survival by cancer type and stage at diagnosis. RESULTS The cohort comprised 412 children, of whom 49% (n = 202) died within 5 years of diagnosis. Five-year survival ranged from 28% (95% confidence interval [CI]: 12.5%-45.6%) for BL to 68% (CI: 55%-78%) for retinoblastoma. For the cancers for which staging was carried out, it was assigned for 83% patients (n = 301 of 362), with over half (58%) having limited or localised stage at diagnosis. Stage was a strong predictor of survival; for example, 3-year survival was 70% (95% CI: 45.1%-85.3%) and 11.8% (2.0%-31.2%) for limited and advanced non-HL, respectively (p < .001). CONCLUSION This study is only the second to report on stage distribution and stage-specific survival for childhood cancers in sub-Saharan Africa. It demonstrates the feasibility of the Toronto Stage Guidelines in a low-resource setting, and highlights the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.
Collapse
Affiliation(s)
- Lydia Businge
- Rwanda Biomedical Centre (RBC), Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | | | - Melitah Motlhale
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Aude Bardot
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Biying Liu
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford OX2 7HT, UK
| | - Kathryn Anastos
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
- Departments of Medicine and of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Philip E. Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | | | | | | | - Gallican Kubwimana
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Theoneste Maniragaba
- Rwanda Biomedical Centre (RBC), Kigali, Rwanda
- Rwanda Military Hospital, Kigali, Rwanda
| | | | | | | | - Donald Maxwell Parkin
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford OX2 7HT, UK
| |
Collapse
|
2
|
Lukamba RM, Budiongo AN, Monga BB, Yao A, Bey P, Chenge GB, Desjardins L, Doz F, Mwembo AT, Kabesha TA, Luboya ON. Treatment adherence in retinoblastoma: A retro-prospective cohort study in Ivory Coast and the Democratic Republic of Congo. Cancer Rep (Hoboken) 2023; 7:e1949. [PMID: 38146612 PMCID: PMC10849925 DOI: 10.1002/cnr2.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND In high-income countries, retinoblastoma is curable in more than 95% of cases, whereas in low-income countries, mortality remains high, especially when the diagnosis is made late or the treatment is discontinued. AIMS To determine the factors associated with adherence to the treatment of retinoblastoma in the Ivory Coast and the Democratic Republic of Congo (DRC). METHODS AND RESULTS A retro-prospective cohort study was carried out. Data were collected from patient folders and follow-up records of parents. RESULTS A total of 175 children with retinoblastoma were registered from January 2013 to December 2015. Seventy-six children (43%) were 5 years old and above. Care costs were covered by families in 86.9% of cases. Chemotherapy refusal was recorded in 39 cases (22.3%), and enucleation refusal was recorded in 79 cases (45.1%). After 36 months of follow-up, we recorded 16.6% deaths, 27.4% treatment dropouts, and 18.3% loss to follow-up after treatment. The commonest cause for enucleation refusal was fear of infirmity, while chemotherapy refusal and absconding treatment were due to financial constraints. CONCLUSION Poor adherence to retinoblastoma management was due to financial constraints, and a lack of knowledge of the disease and its treatment. Family psychosocial support is needed to improve this condition.
Collapse
Affiliation(s)
- Robert Mbuli Lukamba
- Department of Pediatrics (Pediatric Oncology Unit)University of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Aléine Nzazi Budiongo
- Department of Pediatrics (Pediatric Oncology Unit)University of KinshasaKinshasaDemocratic Republic of the Congo (DRC)
| | - Ben Bondo Monga
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Atteby Yao
- Pediatric Oncology UnitUniversity Teaching Hospital of TreichvilleAbidjanIvory Coast
| | - Pierre Bey
- Advisor to the President of Institut CurieUniversity of Lorraine and AMCCParisFrance
| | | | | | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research in Child Oncology, Adolescent and Young Adult) Institut Curie and University Paris CitéParisFrance
| | - Albert Tambwe Mwembo
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | | | - Oscar Numbi Luboya
- Department of Pediatrics and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| |
Collapse
|
3
|
Gramatges MM. Poverty and health equity in childhood leukemia. Blood 2023; 142:211-212. [PMID: 37471111 PMCID: PMC10375267 DOI: 10.1182/blood.2023020565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
|
4
|
Majaliwa E, Smith ER, Cotache-Condor C, Rice H, Gwanika Y, Canick J, Chao N, Schroeder K, Rice HE, Staton C, Mmbaga BT. Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study. JCO Glob Oncol 2023; 9:e2200263. [PMID: 37384861 PMCID: PMC10497254 DOI: 10.1200/go.22.00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
Collapse
Affiliation(s)
- Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hannah Rice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yotham Gwanika
- Kilimanjaro Cancer Registry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julia Canick
- Duke Global Health Institute, Duke University, Durham, NC
| | - Nelson Chao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| |
Collapse
|
5
|
Cotache-Condor C, Rice HE, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Delays in cancer care for children in low-income and middle-income countries: development of a composite vulnerability index. Lancet Glob Health 2023; 11:e505-e515. [PMID: 36925171 PMCID: PMC10938288 DOI: 10.1016/s2214-109x(23)00053-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Early access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries. METHODS The composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries. FINDINGS We found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa. INTERPRETATION Our composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs. FUNDING None. TRANSLATIONS For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | | | - Kristin Schroeder
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, NC, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA; Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, NC, USA.
| |
Collapse
|
6
|
Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
Collapse
Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Cotache-Condor C, Kantety V, Grimm A, Williamson J, Landrum KR, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2023; 70:e30175. [PMID: 36579761 DOI: 10.1002/pbc.30175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
Collapse
Affiliation(s)
| | - Vinootna Kantety
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama, USA
| | | | - Kelsey R Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| |
Collapse
|
8
|
López C, Burkhardt B, Chan JKC, Leoncini L, Mbulaiteye SM, Ogwang MD, Orem J, Rochford R, Roschewski M, Siebert R. Burkitt lymphoma. Nat Rev Dis Primers 2022; 8:78. [PMID: 36522349 DOI: 10.1038/s41572-022-00404-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/16/2022]
Abstract
Burkitt lymphoma (BL) is an aggressive form of B cell lymphoma that can affect children and adults. The study of BL led to the identification of the first recurrent chromosomal aberration in lymphoma, t(8;14)(q24;q32), and subsequent discovery of the central role of MYC and Epstein-Barr virus (EBV) in tumorigenesis. Most patients with BL are cured with chemotherapy but those with relapsed or refractory disease usually die of lymphoma. Historically, endemic BL, non-endemic sporadic BL and the immunodeficiency-associated BL have been recognized, but differentiation of these epidemiological variants is confounded by the frequency of EBV positivity. Subtyping into EBV+ and EBV- BL might better describe the biological heterogeneity of the disease. Phenotypically resembling germinal centre B cells, all types of BL are characterized by dysregulation of MYC due to enhancer activation via juxtaposition with one of the three immunoglobulin loci. Additional molecular changes commonly affect B cell receptor and sphingosine-1-phosphate signalling, proliferation, survival and SWI-SNF chromatin remodelling. BL is diagnosed on the basis of morphology and high expression of MYC. BL can be effectively treated in children and adolescents with short durations of high dose-intensity multiagent chemotherapy regimens. Adults are more susceptible to toxic effects but are effectively treated with chemotherapy, including modified versions of paediatric regimens. The outcomes in patients with BL are good in high-income countries with low mortality and few late effects, but in low-income and middle-income countries, BL is diagnosed late and is usually treated with less-effective regimens affecting the overall good outcomes in patients with this lymphoma.
Collapse
Affiliation(s)
- Cristina López
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Birgit Burkhardt
- Non-Hodgkin's Lymphoma Berlin-Frankfurt-Münster (NHL-BFM) Study Center and Paediatric Hematology, Oncology and BMT, University Hospital Muenster, Muenster, Germany
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Lorenzo Leoncini
- Section of Pathology, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | | | | | - Rosemary Rochford
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.
| |
Collapse
|
9
|
McAleer MF, Melchior P, Parkes J, Pater L, Rübe C, Saunders D, Paulino AC, Janssens GO, Kalapurakal J. Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors. Pediatr Blood Cancer 2022; 70 Suppl 2:e30090. [PMID: 36482883 DOI: 10.1002/pbc.30090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
Radiotherapy (RT) is essential for multimodality treatment of pediatric renal tumors, particularly in higher-risk and metastatic disease. Despite decades of use, particularly for Wilms tumor, there remain controversies regarding RT indications, timing, dose, and targets. To align global management, we address these issues in this international HARMONIsation and CollAboration (HARMONICA) project. There are multiple knowledge gaps and opportunities for future research including: (1) utilization of advanced RT technologies, including intensity-modulated RT, proton beam therapy, combined with image-guided RT to reduce target volumes; (2) impact of molecular biomarkers including loss of heterozygosity at 1p, 16q, and 1q gain on RT indications; (3) mitigation of reproductive toxicity following RT; (4) promotion of RT late effects research; and (5) support to overcome challenges in RT utilization in low- and middle-income countries where 90% of the world's children reside. Here, we outline current status and future directions for RT in pediatric renal tumors.
Collapse
Affiliation(s)
- Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Low- and Middle-Income Countries Committee Co-Chair, Paediatric Radiation Oncology Society, Cape Town, South Africa
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
10
|
Shyirambere C, Villaverde C, Nguyen C, Ruhangaza D, Umwizerwa A, Nsanzimana O, Mujyuwisha L, Iradukunda E, Shulman LN, Lehmann L. Nephroblastoma Treatment and Outcomes in a Low-Income Setting. JCO Glob Oncol 2022; 8:e2200036. [PMID: 35820081 PMCID: PMC9296183 DOI: 10.1200/go.22.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nephroblastoma is a highly curable pediatric cancer that requires multidisciplinary care. Few reports have assessed long-term treatment outcomes in low-resource settings using a task-shifting model of care. We report outcomes of a large cohort and factors associated with survival. METHODS We performed a retrospective chart review of all patients with nephroblastoma presenting to the Butaro Cancer Center of Excellence in Rwanda between July 2012 and June 2018. RESULTS In total, 136 patients were identified and treated according to International Society of Pediatric Oncology guidelines for low-income settings. Median age at diagnosis was 39.7 months (interquartile range, 25.3-61.8 months); 56.6% were female. Sixty-one (44.9%) patients presented with stage I-III disease, 35 (25.7%) with stage IV disease, and 6 (4.4%) with stage V disease; the remainder were unstaged (n = 34; 25.0%). Most patients completed surgery (n = 97; 71.3%) and postoperative chemotherapy (n = 82; 60.2%); 17 patients received radiotherapy. With a median follow-up time of 18.1 months, 44.9% of patients were alive, 41.9% had died, 8.8% were lost to follow-up, and 4.4% were referred for palliative care or declined further care at the end of the study. Three-year overall survival was 57.5% (95% CI, 48.1 to 65.8) for the entire cohort, and 80.1% (95% CI, 66.8 to 88.5) and 44.0% (95% CI, 26.8 to 60.0) for stages I-III and IV-V, respectively. CONCLUSION We demonstrate that patients with nephroblastoma can be successfully treated in a low-resource setting. Survival remains lower than in high-income countries, in part due to early deaths, contributing to approximately 30% of patients not being medically able to receive surgical intervention. Next steps include the development of strategies that focus on earlier diagnosis, supportive care during the early phases of therapy, and efficient and timely transitions between specialties for multimodal care.
Collapse
Affiliation(s)
| | | | - Cam Nguyen
- University of Colorado Cancer Center, Aurora, CO
| | | | | | | | | | | | | | - Leslie Lehmann
- Children's Hospital Boston, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
11
|
Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder K, Staton CA, Majaliwa E, Rice HE, Smith ER. Factors contributing to delayed childhood cancer care in low- and middle-income countries: A systematic review protocol. Pediatr Blood Cancer 2022; 69:e29646. [PMID: 35253351 DOI: 10.1002/pbc.29646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Significant disparities exist for timely access to cancer care for children, with the highest disparities in low- and middle-income countries (LMICs). This study aims to conduct a systematic review that identifies the factors contributing to delayed care of childhood cancers in LMICs. METHODS We will conduct a systematic review with search strings compliant with the PICO framework: (1) the Population-children (aged 0-18 years) from LMICs; (2) the Exposure-factors contributing to timely childhood cancer care; (3) the Outcome-delays in childhood cancer care. DISCUSSION Our study is an essential step to guide strategic interventions to assess the myriad of factors that prevent children from accessing timely cancer care in LMICs. The results will be submitted for publication in a peer-reviewed journal and shared with institutions related to the field.
Collapse
Affiliation(s)
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama
| | | | | | - Kelsey Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| |
Collapse
|
12
|
Luo Y, Zhou C, He F, Fan J, Wen X, Ding Y, Han Y, Ding J, Jin M, Liu Z, Wang S, Han M, Yuan H, Sun H, Xiao Y, Wu L, Wang J, Li Y, Yang H, Yu J, Gong J, Xu Y, Wen Y, Gao Z, Mei L, Ye J, Liu H, Chen Z, Xue S, Liu R, Chen H, Lu W, Liao H, Guo Q, Cui J, Zhu D, Lu F, Tang S, Wu Y, Yangkyi T, Guanghong Z, Wubuli M, Huiyu G, Wang X, He Y, Sheng X, Wang Q, Tan J, Liang J, Sun X, Zhang J, Ji X, Jin L, Zhao J, Yang X, Jia R, Fan X. Contemporary Update of Retinoblastoma in China: Three-Decade Changes in Epidemiology, Clinical Features, Treatments, and Outcomes. Am J Ophthalmol 2022; 236:193-203. [PMID: 34626572 DOI: 10.1016/j.ajo.2021.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/30/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To report three-decade changes of clinical characteristics, progress of treatments, and risk factors associated with mortality and enucleation in patients with retinoblastoma in China. DESIGN Retrospective cohort study. METHODS This multicenter study included 2552 patients diagnosed with retinoblastoma in 38 medical centers in 31 provinces in China from 1989 to 2017, with follow-up data. Kendall's tau-b value was used to describe correlation coefficients between the three eras (between 1989 and 2008, between 2009 and 2013, and between 2014 and 2017) and clinical or demographic features. Hazard ratios and odds ratios were applied to measure risk factors. RESULTS A total of 324 (13%) patients died and 1414 (42%) eyes were removed. The 1-year, 3-year, and 5-year overall survival rates were 95%, 86%, and 83%, respectively. Patients were diagnosed at a better stage by International Classification for Retinoblastoma over time (Kendall's tau-b value = -0.084, P < .001). Pathological risk factors were also observed less in recent eras. New conservative therapies were adopted and used in more patients. The eye removal rate gradually decreased (Kendall's tau-b value = -0.167, P < .001). The overall survival rates were 81%, 83%, and 91% in the three eras. By multivariate Cox regression, bilateral tumors and extraocular extension were identified as risk factors for death. Among intraocular disease, Group E indicated higher risk of mortality. By multivariate logistics regression, unilateral tumors, earlier era of diagnosis, and extraocular extension were risk factors for eye salvage failure. Among intraocular retinoblastoma, Groups D and E had higher risk of eye salvage failure. CONCLUSIONS Patients were diagnosed at an earlier stage in recent eras. Conservative therapies, including intra-arterial chemotherapy, were increasingly being used. The above changes may contribute to the decreasing enucleation rate. Although no significant impact was identified on the mortality by the three eras, a decreasing trend was shown.
Collapse
Affiliation(s)
- Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Fanglin He
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Xuyang Wen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Yanping Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Jingwen Ding
- Department of Ophthalmology, Beijing Tongren Hospital (J.D)
| | - Mei Jin
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University (M.J, J.Z)
| | - Zhenyin Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center (Z.L, J.Z)
| | - Sha Wang
- Department of Ophthalmology, Central South University Xiangya School of Medicine (S.W, J.T)
| | - Minglei Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Department of Ophthalmology, Qilu Children's Hospital of Shandong University (M.H)
| | - Hongfeng Yuan
- Department of Ophthalmology, the First hospital Affiliated with AMU (H.Y)
| | - Hong Sun
- Department of Ophthalmology, Shandong Provincial Hospital (H.S)
| | - Yishuang Xiao
- Department of Ophthalmology, Kunming Children's Hospital (Y.X)
| | - Li Wu
- Department of Ophthalmology, Wuhan University Renmin Hospital (L.W)
| | - Jiancang Wang
- Department of Ophthalmology, Hebei Children's Hospital (J.W)
| | - Yangjun Li
- Department of Ophthalmology, Xi'an Tangdu Hospital of No.4 Military Medical University (Y.L)
| | - Huasheng Yang
- Zhongshan Ophthalmic Center, Sun Yat-sen University (H.Y)
| | - Jiawei Yu
- Department of Ophthalmology, Harbin Children's Hospital (J.Y)
| | - Jianyang Gong
- Ophthalmology of the First Affiliated Hospital Anhui Medical University (J.G)
| | - Yuxin Xu
- Department of Ophthalmology, the Second affiliated Hospital of Anhui Medical University (Y.X)
| | - Yuechun Wen
- Department of Ophthalmology, the Provincial Hospital Affiliated to Anhui Medical University (Y.W)
| | - Ziqing Gao
- Department of Ophthalmology, the First Affiliated Hospital of Bengbu Medical College (Z.G)
| | - Lixin Mei
- Department of Ophthalmogy, Yijishan Hospital, Wannan Medical College (L.M)
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital Zhejiang University School of Medicine (J.Y)
| | - Hu Liu
- Jiangsu Province Hospital (H.L)
| | - Zhijun Chen
- Children's Hospital of Nanjing Medical University (Z.C)
| | - Shangcai Xue
- Second Provincial People's Hospital of Gansu (S.X)
| | - Rong Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (R.L)
| | - Hong Chen
- Department of Ophthalmology, Union Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan (H.C)
| | - Wei Lu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University (W.L)
| | - Hongfei Liao
- Department of Ocular Trauma and Orbital Diseases, Affiliated Eye Hospital of Nanchang University (H.L)
| | - Qing Guo
- The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China (Q.G)
| | - Jizhe Cui
- The Second Hospital of Jilin University (J.C)
| | - Dan Zhu
- The Affiliated Hospital of Inner Mongolia Medical University (D.Z)
| | - Fang Lu
- West China Hospital, Sichuan University (F.L)
| | | | - Yu Wu
- People's Hospital of Guangxi Zhuang Autonomous Region (Y.W)
| | | | - Zhang Guanghong
- Beijing Road Clinical Department of Xinjiang Military Command General Hospital Urumqi (Z.G)
| | | | - Guo Huiyu
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (G.H)
| | - Xian Wang
- The Affiliated Hospital of Guizhou Medical University (X.W)
| | - Yanjin He
- Tianjin medical university eye hospital (Y.H)
| | - Xunlun Sheng
- Ning Xia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region (X.S)
| | - Qing Wang
- Qinghai University Affiliated Hospital (Q.W)
| | - Jia Tan
- Department of Ophthalmology, Central South University Xiangya School of Medicine (S.W, J.T)
| | - Jianhong Liang
- Department of Ophthalmology, Peking University People's Hospital (J.L)
| | - Xiantao Sun
- Department of Ophthalmology, Henan Children's Hospital (X.S)
| | - Jing Zhang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center (Z.L, J.Z)
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital affiliated with Shanghai Jiaotong University School of Medicine (L.J)
| | - Liwen Jin
- Department of Ophthalmology, Quanzhou Women's and Children's Hospital (L.J)
| | - Junyang Zhao
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University (M.J, J.Z)
| | - Xinji Yang
- Department of Ophthalmology, The General Hospital of Chinese People's Armed Police Forces (X.Y)
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F).
| |
Collapse
|
13
|
Simplified Detection of Epstein-Barr Virus for Diagnosis of Endemic Burkitt Lymphoma. Blood Adv 2022; 6:3650-3654. [PMID: 35240680 DOI: 10.1182/bloodadvances.2022007297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
|
14
|
Major A, Palese M, Ermis E, James A, Villarroel M, Klussmann FA, Hessissen L, Geel J, Khan MS, Dalvi R, Sullivan M, Kearns P, Frazier AL, Pritchard-Jones K, Nakagawara A, Rodriguez-Galindo C, Volchenboum SL. Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage. JCO Glob Oncol 2022; 8:e2100266. [PMID: 35157510 PMCID: PMC8853619 DOI: 10.1200/go.21.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer. Local stakeholder engagement is necessary to collaborate with global pediatric cancer trial groups.![]()
Collapse
Affiliation(s)
- Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Monica Palese
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Ebru Ermis
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Anthony James
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Milena Villarroel
- Grupo de América Latina de Oncología Pediátrica (GALOP), Hospital Luis Calvo Mackenna, National Pediatric Cancer Program (PINDA), Santiago, Chile
| | - Federico Antillon Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Laila Hessissen
- Pediatric Hematology and Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Saudi Arabia
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
| | | | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | | |
Collapse
|
15
|
Chakravorty S, Afzali B, Kazemian M. EBV-associated diseases: Current therapeutics and emerging technologies. Front Immunol 2022; 13:1059133. [PMID: 36389670 PMCID: PMC9647127 DOI: 10.3389/fimmu.2022.1059133] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
EBV is a prevalent virus, infecting >90% of the world's population. This is an oncogenic virus that causes ~200,000 cancer-related deaths annually. It is, in addition, a significant contributor to the burden of autoimmune diseases. Thus, EBV represents a significant public health burden. Upon infection, EBV remains dormant in host cells for long periods of time. However, the presence or episodic reactivation of the virus increases the risk of transforming healthy cells to malignant cells that routinely escape host immune surveillance or of producing pathogenic autoantibodies. Cancers caused by EBV display distinct molecular behaviors compared to those of the same tissue type that are not caused by EBV, presenting opportunities for targeted treatments. Despite some encouraging results from exploration of vaccines, antiviral agents and immune- and cell-based treatments, the efficacy and safety of most therapeutics remain unclear. Here, we provide an up-to-date review focusing on underlying immune and environmental mechanisms, current therapeutics and vaccines, animal models and emerging technologies to study EBV-associated diseases that may help provide insights for the development of novel effective treatments.
Collapse
Affiliation(s)
- Srishti Chakravorty
- Department of Biochemistry, Purdue University, West Lafayette, IN, United States
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Majid Kazemian
- Department of Biochemistry, Purdue University, West Lafayette, IN, United States.,Department of Computer Science, Purdue University, West Lafayette IN, United States
| |
Collapse
|
16
|
Wong ES, Choy RW, Zhang Y, Chu WK, Chen LJ, Pang CP, Yam JC. Global retinoblastoma survival and globe preservation: a systematic review and meta-analysis of associations with socioeconomic and health-care factors. THE LANCET GLOBAL HEALTH 2022; 10:e380-e389. [DOI: 10.1016/s2214-109x(21)00555-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
|
17
|
Parkin DM, Youlden DR, Chitsike I, Chokunonga E, Couitchéré L, Gnahatin F, Nambooze S, Wabinga H, Aitken JF. Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub-Saharan Africa. Int J Cancer 2021; 148:2685-2691. [PMID: 33433927 DOI: 10.1002/ijc.33468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.
Collapse
Affiliation(s)
- Donald Maxwell Parkin
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- African Cancer Registry Network, INCTR, Oxford, UK
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Inam Chitsike
- Paediatric Heme-Oncology Unit, University of Zimbabwe, Harare, Zimbabwe
| | | | - Line Couitchéré
- Pediatric Unit, Teaching Hospital of Treichville, Félix Houphouët Boigny Université, Abidjan, Côte d'Ivoire
| | - Franck Gnahatin
- Registre du Cancer d'Abidjan (RCA), Programme National de Lutte contre le Cancer (PNLCa), Ministère de la Santé et de l'Hygiène Publique (MSHP), Abidjan, Côte d'Ivoire
| | - Sarah Nambooze
- Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
18
|
Hanis TM, Yaacob NM, Mohd Hairon S, Abdullah S. Net survival differences of breast cancer between stages at diagnosis and age groups in the east coast region of West Malaysia: a retrospective cohort study. BMJ Open 2021; 11:e043642. [PMID: 34006546 PMCID: PMC8130742 DOI: 10.1136/bmjopen-2020-043642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Estimation of the net survival of breast cancer helps in assessing breast cancer burden at a population level. Thus, this study aims to estimate the net survival of breast cancer at different cancer staging and age at diagnosis in the east coast region of West Malaysia. SETTING Kelantan, Malaysia. PARTICIPANTS All breast cancer cases diagnosed in 2007 and 2011 identified from Kelantan Cancer Registry. DESIGN This retrospective cohort study used a relative survival approach to estimate the net survival of patients with breast cancer. Thus, two data were needed; breast cancer data from Kelantan Cancer Registry and general population mortality data for Kelantan population. PRIMARY AND SECONDARY OUTCOME MEASURES Net survival according to stage and age group at diagnosis at 1, 3 and 5 years following diagnosis. RESULTS The highest net survival was observed among stage I and II breast cancer cases, while the lowest net survival was observed among stage IV breast cancer cases. In term of age at diagnosis, breast cancer cases aged 65 and older had the best net survival compared with the other age groups. CONCLUSION The age at diagnosis had a minimal impact on the net survival compared with the stage at diagnosis. The finding of this study is applicable to other populations with similar breast cancer profile.
Collapse
Affiliation(s)
- Tengku Muhammad Hanis
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Sarimah Abdullah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| |
Collapse
|
19
|
Liu B, Youlden DR, Wabinga H, Nambooze S, Amulen PM, Aitken JF, Parkin DM. Survival from childhood cancer in Kampala, Uganda. Pediatr Blood Cancer 2021; 68:e28876. [PMID: 33381877 DOI: 10.1002/pbc.28876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022]
Abstract
Population-based data on survival from childhood cancers in sub-Saharan Africa are sparse. We report data on 221 children with cancer diagnosed between 2010 and 2014 in the population of Kampala, Uganda. Survival for eight of nine children with cancer assessed was below the WHO's global target of 60% (the exception was Hodgkin lymphoma: 86% at 3 years). There was significant (P < .05) decline in survival between 1 and 3 years for Wilms tumour and Kaposi sarcoma (30% and 34% at 3 years, respectively). Survival from Burkitt lymphoma, Wilms tumour and Kaposi sarcoma has not changed compared with results from the 2005-2009 study.
Collapse
Affiliation(s)
- Biying Liu
- African Cancer Registry Network, INCTR, Oxford, UK
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Nambooze
- Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Phoebe Mary Amulen
- Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Donald Maxwell Parkin
- International Agency for Research on Cancer, Lyon, France
- Nuffield Department of Population health, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The high cure rates of children with cancer in high-income countries (HICs) are due to the impact of biomedical innovations on children with highly fatal diseases. We discuss why these innovations have not benefitted most children with cancer globally and propose broad strategies to reduce these disparities. RECENT FINDINGS Over 85% of children with cancer in HIC are cured while less than 20% in many low-income countries survive the disease. Hence, childhood cancer survival is poor globally since over 80% of children with cancer live in low-income and middle-income countries (LMICs). Inadequate skilled workforce and health infrastructure across all disciplines of pediatrics in LMIC are the main reasons for these disparities. Although biological differences may contribute to these disparities as well, many are unconfirmed because they are confounded by differences in referral patterns and clinical capacity. HIC partnerships with LMIC that focus on locally based pediatrics training and clinical infrastructure building are beginning to close the gap. SUMMARY Pediatric oncology is symbolic of the significant disparities in childhood survival arising from poverty, inadequate pediatric infrastructure, and skilled workforce in LMIC. Partnerships with HIC that build multidisciplinary pediatrics capacity and clinical infrastructure are beginning to make transformative improvements.
Collapse
Affiliation(s)
- Joseph Lubega
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital Global HOPE Program, Houston, Texas, USA
| | - Robert L Kimutai
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Murali M Chintagumpala
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital Global HOPE Program, Houston, Texas, USA
| |
Collapse
|
21
|
Gao S, Chu Q, Liu X, Zhao X, Qin L, Li G, Liu Q. Long Noncoding RNA HEIH Promotes Proliferation, Migration and Invasion of Retinoblastoma Cells Through miR-194-5p/WEE1 Axis. Onco Targets Ther 2020; 13:12033-12041. [PMID: 33262604 PMCID: PMC7695688 DOI: 10.2147/ott.s268942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Abnormally expressed long noncoding RNA (lncRNA) high expression in hepatocellular carcinoma (HEIH) has been implicated in many types of human cancer, and plays crucial roles in tumor development and progression. However, little is known about its function in retinoblastoma. Methods qRT-PCR was used to determine the expression levels of HEIH, miR-194-5p and WEE1 in retinoblastoma tissues and cell lines. The trypan blue exclusion method, colony formation assay, wound-healing assay and transwell invasion assay were performed to evaluate the effects of HEIH, miR-194-5p and WEE1 on cell proliferation, migration and invasion. Bioinformatics analysis, dual-luciferase reporter assay and Western blot were employed to investigate the regulatory relationship among HEIH, miR-194-5p and WEE1. Results We found that HEIH was up-regulated in retinoblastoma tissues and cell lines. Furthermore, high level of HEIH was associated with TNM stage, optic nerve invasion and choroidal invasion of patients with retinoblastoma. Functional studies showed that HEIH knockdown significantly suppressed retinoblastoma cell proliferation, migration and invasion. Mechanistically, HEIH promoted retinoblastoma progression by serving as a sponge of miR-194-5p to regulate WEE1 expression. Conclusion Our work suggests that HEIH acts as an oncogenic lncRNA to promote retinoblastoma proliferation and metastasis, providing a new insight into the retinoblastoma treatment.
Collapse
Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, Nanjing Pukou Central Hospital, Nanjing 211800, People's Republic of China
| | - Qingxia Chu
- Department of Ophthalmology, Nanjing Pukou Central Hospital, Nanjing 211800, People's Republic of China
| | - Xia Liu
- Department of Ophthalmology, Nanjing Pukou Central Hospital, Nanjing 211800, People's Republic of China
| | - Xia Zhao
- Department of Ophthalmology, Tangshan Eye Hospital, Tangshan 063000, People's Republic of China
| | - Libao Qin
- Department of Ophthalmology, Nanjing Pukou Central Hospital, Nanjing 211800, People's Republic of China
| | - Guoliang Li
- Department of Ophthalmology, Nanjing Pukou Central Hospital, Nanjing 211800, People's Republic of China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, People's Republic of China
| |
Collapse
|
22
|
Omonisi AE, Liu B, Parkin DM. Population-Based Cancer Registration in Sub-Saharan Africa: Its Role in Research and Cancer Control. JCO Glob Oncol 2020; 6:1721-1728. [PMID: 33180635 PMCID: PMC7713579 DOI: 10.1200/go.20.00294] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Abidemi Emmanuel Omonisi
- Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Nigeria
- Ekiti Cancer Registry, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
23
|
Ford K, Gunawardana S, Manirambona E, Philipoh GS, Mukama B, Kanyamuhunga A, Cartledge P, Nyoni MJ, Mwaipaya D, Mpwaga J, Bokhary Z, Scanlan T, Heinsohn T, Hathaway H, Mansfield R, Wilson S, Lakhoo K. Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study. World J Surg 2020; 44:295-302. [PMID: 31605179 DOI: 10.1007/s00268-019-05213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT). METHODS This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death). RESULTS There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X2 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X2 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks. CONCLUSIONS This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.
Collapse
Affiliation(s)
- K Ford
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | | | - E Manirambona
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - G S Philipoh
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - B Mukama
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - A Kanyamuhunga
- Department of Pediatric Oncology, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - P Cartledge
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.,Yale University, New Haven, USA
| | - M J Nyoni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - D Mwaipaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J Mpwaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Z Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - T Scanlan
- Department of Pediatric Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | - S Wilson
- Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK
| | - K Lakhoo
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. .,Oxford University, Oxford, UK. .,Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania. .,Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK.
| |
Collapse
|
24
|
Afungchwi GM, Hesseling PB, Kouya F, Enow SA, Kruger M. The outcome and cost of a capacity-building training programme on the early recognition and referral of childhood cancer for healthcare workers in North-West Cameroon. Nurs Open 2020; 7:2029-2038. [PMID: 33072388 PMCID: PMC7544884 DOI: 10.1002/nop2.598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
Aim Early cancer diagnosis is necessary to improve survival rates. The aim of this study was to assess the outcome and cost of the childhood cancer training programme amongst healthcare workers. Design This was a prospective pre–post study design, using questionnaires for pre‐ and post‐training testing. The warning signs of childhood cancer were used as the main teaching content to improve recognition and early diagnosis. Methods Pre‐training and post‐training knowledge, as well as attitude questionnaires, was administered at the beginning and at the end of each training workshop. Paired samples t test and chi‐square were used to compare the change in knowledge and differences between groups. Results The overall percentage knowledge score increased from 51%–85% (p < .001). The doctors had a better knowledge score than the nurses in the pre‐test (70% versus 50%, p = .008), but there was no significant difference in the post‐test scores. The cost of training was €25.06 per healthcare worker. Conclusion We recommend similar training programmes in public health to improve early diagnosis of childhood cancer.
Collapse
Affiliation(s)
- Glenn Mbah Afungchwi
- Mbingo Baptist Hospital Mbingo Cameroon.,Department of Paediatrics and Child Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
| | - Peter Bernard Hesseling
- Department of Paediatrics and Child Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
| | | | - Sam A Enow
- Regional delegation of Public Health Bafoussam Cameroon.,School for State Registered Nurses Bafoussam Cameroon
| | - Mariana Kruger
- Department of Paediatrics and Child Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
| |
Collapse
|
25
|
Smith-Togobo C, Pedersen MØ, Jensen SG, Duduyemi B, Gyasi RK, Ofori MF, Paintsil V, Renner L, Nørgaard P, Hviid L. Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana. BMC Cancer 2019; 19:1270. [PMID: 31888714 PMCID: PMC6937736 DOI: 10.1186/s12885-019-6488-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). METHODS The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N = 55) or non-eBL (N = 56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements. RESULTS We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. CONCLUSION We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
Collapse
Affiliation(s)
- Cecilia Smith-Togobo
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Ø Pedersen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steffen G Jensen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Richard K Gyasi
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Peter Nørgaard
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
26
|
Miguel F, Bento MJ, de Lacerda GF, Weiderpass E, Santos LL. A hospital-based cancer registry in Luanda, Angola: the Instituto Angolano de Controlo do Cancer (IACC) Cancer registry. Infect Agent Cancer 2019; 14:35. [PMID: 31719840 PMCID: PMC6839121 DOI: 10.1186/s13027-019-0249-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022] Open
Abstract
Background The Instituto Angolano de Controlo do Cancer (IACC) Cancer Registry in Luanda, Angola is the most ancient and organized hospital-based cancer registry in Angola and provides data on cancer cases treated in several hospital facilities in Luanda. Methods Newly-diagnosed cancer cases (2012–2016) of IACC were collected. A total of 6638 malignant neoplasms were recorded. After excluding duplicates, missing data and non-melanoma skin cancers cases, a final number of 5609 cancer cases was considered valid for analysis. Results From 5609 new cases, 2059 were males and 3550 females. Of all cases, 9.7% was in children below the age of 15 years. Most of the cases were residents from the Luanda district. The five most common cancers for all periods were breast (21.4%), cervix (16.8%), prostate (7.1%), non-Hodgkin lymphoma (4.5%) and Kaposi sarcoma (4.3%). For men, 19.3% of the cancers were prostate, 7.5% Kaposi sarcoma and 7.5% non-Hodgkin lymphoma. Cancers of the breast and cervix together accounted 60% of all cancers in females. Comparison of our data onto the 5 most frequent tumours, by sex, according to GLOBOCAN 2018 estimations for Angola, highlights the potential deviation from reality that estimates may have and reinforces the urgent need to build a truly population-based cancer registry in Luanda. Conclusion To accomplish that task, it is mandatory to implement a more rigorous quality control program at the hospital-based cancer registry at IACC and to optimize the network of health institutions that actively working on and contributing to the cancer registry, in Luanda.
Collapse
Affiliation(s)
| | - Maria José Bento
- 2Department of Epidemiology, Portuguese Institute of Oncology, Porto, Portugal.,3Cancer Epidemiology Research Group, Portuguese Institute of Oncology, Porto, Portugal
| | - Gonçalo Forjaz de Lacerda
- 4Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD USA
| | | | - Lúcio Lara Santos
- 6Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Rua Dr. António Bernardino de Almeida, PT-4200-072 Porto, Portugal.,ONCOCIR- Education and Care in Oncology in Lusophone African Countries, Porto, Portugal
| |
Collapse
|
27
|
Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
Collapse
Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| |
Collapse
|
28
|
Grande BM, Gerhard DS, Jiang A, Griner NB, Abramson JS, Alexander TB, Allen H, Ayers LW, Bethony JM, Bhatia K, Bowen J, Casper C, Choi JK, Culibrk L, Davidsen TM, Dyer MA, Gastier-Foster JM, Gesuwan P, Greiner TC, Gross TG, Hanf B, Harris NL, He Y, Irvin JD, Jaffe ES, Jones SJM, Kerchan P, Knoetze N, Leal FE, Lichtenberg TM, Ma Y, Martin JP, Martin MR, Mbulaiteye SM, Mullighan CG, Mungall AJ, Namirembe C, Novik K, Noy A, Ogwang MD, Omoding A, Orem J, Reynolds SJ, Rushton CK, Sandlund JT, Schmitz R, Taylor C, Wilson WH, Wright GW, Zhao EY, Marra MA, Morin RD, Staudt LM. Genome-wide discovery of somatic coding and noncoding mutations in pediatric endemic and sporadic Burkitt lymphoma. Blood 2019; 133:1313-1324. [PMID: 30617194 PMCID: PMC6428665 DOI: 10.1182/blood-2018-09-871418] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/22/2018] [Indexed: 12/12/2022] Open
Abstract
Although generally curable with intensive chemotherapy in resource-rich settings, Burkitt lymphoma (BL) remains a deadly disease in older patients and in sub-Saharan Africa. Epstein-Barr virus (EBV) positivity is a feature in more than 90% of cases in malaria-endemic regions, and up to 30% elsewhere. However, the molecular features of BL have not been comprehensively evaluated when taking into account tumor EBV status or geographic origin. Through an integrative analysis of whole-genome and transcriptome data, we show a striking genome-wide increase in aberrant somatic hypermutation in EBV-positive tumors, supporting a link between EBV and activation-induced cytidine deaminase (AICDA) activity. In addition to identifying novel candidate BL genes such as SIN3A, USP7, and CHD8, we demonstrate that EBV-positive tumors had significantly fewer driver mutations, especially among genes with roles in apoptosis. We also found immunoglobulin variable region genes that were disproportionally used to encode clonal B-cell receptors (BCRs) in the tumors. These include IGHV4-34, known to produce autoreactive antibodies, and IGKV3-20, a feature described in other B-cell malignancies but not yet in BL. Our results suggest that tumor EBV status defines a specific BL phenotype irrespective of geographic origin, with particular molecular properties and distinct pathogenic mechanisms. The novel mutation patterns identified here imply rational use of DNA-damaging chemotherapy in some patients with BL and targeted agents such as the CDK4/6 inhibitor palbociclib in others, whereas the importance of BCR signaling in BL strengthens the potential benefit of inhibitors for PI3K, Syk, and Src family kinases among these patients.
Collapse
Affiliation(s)
- Bruno M Grande
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Aixiang Jiang
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Nicholas B Griner
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Thomas B Alexander
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Leona W Ayers
- Department of Pathology, The Ohio State University, Columbus, OH
| | | | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Jay Bowen
- Nationwide Children's Hospital, Columbus, OH
| | - Corey Casper
- Infectious Disease Research Institute, Seattle, WA
| | - John Kim Choi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Luka Culibrk
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Tanja M Davidsen
- Cancer Informatics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maureen A Dyer
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Julie M Gastier-Foster
- Nationwide Children's Hospital, Columbus, OH
- Departments of Pathology and Pediatrics, The Ohio State University, Columbus, OH
| | - Patee Gesuwan
- Cancer Informatics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Thomas G Gross
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Nancy Lee Harris
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yiwen He
- Cancer Informatics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - John D Irvin
- Foundation for Burkitt Lymphoma Research, Geneva, Switzerland
| | - Elaine S Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven J M Jones
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Patrick Kerchan
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | - Nicole Knoetze
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Fabio E Leal
- Programa de Oncovirologia, Instituto Nacional de Câncer José de Alencar, Rio de Janeiro, Brazil
| | | | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Karen Novik
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; and
| | - Christopher K Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - John T Sandlund
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Roland Schmitz
- Lymphoid Malignancies Branch, Center for Cancer Research and
| | | | | | - George W Wright
- Biometric Research Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eric Y Zhao
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ryan D Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research and
| |
Collapse
|
29
|
Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care. CHILDREN-BASEL 2018; 5:children5110143. [PMID: 30360527 PMCID: PMC6262277 DOI: 10.3390/children5110143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/13/2022]
Abstract
International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered solid tumor of childhood and has been the primary target of recent efforts to improve outcomes in low-resource settings. Aggressive and treatment-resistant tumor biology may play a role in poor outcomes within certain populations, but socioeconomic barriers remain the principal drivers of preventable mortality. Management protocols that include measures to address socioeconomic barriers have demonstrated early success in reducing abandonment of therapy. Further work is required to improve infrastructure and general pediatric care to address disparities.
Collapse
|