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Kayiira A, McLaughlin S, John JN, Zaake D, Xiong S, Balagadde JK, Gomez-Lobo V, Wabinga H, Ghebre R. Future Fertility Among Pediatric Cancer Patients: Experiences and Perspectives of Health Workers in a Low-Resource Setting. J Adolesc Young Adult Oncol 2024; 13:637-645. [PMID: 38613474 PMCID: PMC11322621 DOI: 10.1089/jayao.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.
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Affiliation(s)
- Anthony Kayiira
- Department of Obstetrics and Gynaecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
- Department of Reproductive Endocrinology and Infertility, Mulago Specialized Women’s and Neonatal Hospital, Kampala, Uganda
| | - Sarah McLaughlin
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | - Daniel Zaake
- Department of Obstetrics and Gynaecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
| | - Serena Xiong
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | | | - Veronica Gomez-Lobo
- Department of Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health, and Human Development, Bethesda, Maryland, USA
| | - Henry Wabinga
- Kampala Cancer Registry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, USA
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Hordofa DF, Ahmed M, Birhanu Z, Weitzman S, Broas J, Shad A, Bonilla M, Alexander TB. Childhood cancer presentation and initial outcomes in Ethiopia: Findings from a recently opened pediatric oncology unit. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003379. [PMID: 38985815 PMCID: PMC11236196 DOI: 10.1371/journal.pgph.0003379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
There were no pediatric oncology centers in southwest Ethiopia prior to 2016. This study aims to describe presenting diagnoses and initial outcomes at Jimma University Medical Center (JUMC), the first pediatric oncology unit (POU) in southwest Ethiopia, provide initial insights into regional pediatric cancer epidemiology, illustrate the rapid growth of pediatric cancer services, and highlight ongoing challenges. We used a retrospective descriptive approach to assess the epidemiologic pattern and initial treatment outcomes of pediatric cancer at JUMC POU from August 2016 through December 2022. During the study period, 749 children were diagnosed with cancer at JUMC. The mean age was 7.2 years (20 days-18 years). Acute lymphoblastic leukemia was the most common diagnosis (16.4%), followed by non-Hodgkin lymphoma (12.4%), Wilms tumor (11.1%), soft tissue sarcoma (8.8%), Hodgkin lymphoma (8.4%), and retinoblastoma (8.3%). Brain tumors accounted for only 2.7% of the diagnoses. Of the 703 patients that were not referred elsewhere, 42% of the patients abandoned treatment, 29% died, 17% completed treatment, and 7% remained on treatment at the time of this assessment. The findings emphasize the growth in the diagnosis and treatment of children with cancer in the southwest region of Ethiopia. The data suggests a different epidemiologic profile of childhood cancer cases diagnosed at the JUMC POU compared to high-income countries and neighbouring countries in Africa. Treatment abandonment remains a barrier to care. Ongoing areas of focus include establishment of a hospital-based cancer registry, reduction of treatment abandonment, improvement of diagnostic capacity, and increased access to advanced supportive care.
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Affiliation(s)
- Diriba Fufa Hordofa
- Department of Pediatrics and Child health, Jimma University, Jimma, Ethiopia
| | - Muktar Ahmed
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | | | - Julie Broas
- The Aslan Project, Inc., Washington, DC, United States of America
| | - Aziza Shad
- The Aslan Project, Inc., Washington, DC, United States of America
- Department of Pediatrics, The Herman and Walter Samuelson Children’s Hospital at Sinai, Baltimore, Maryland, United States of America
| | - Miguel Bonilla
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Thomas B. Alexander
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Belay A, Ali A, Ayele W, Assefa M, Jemal A, Kantelhardt EJ. Incidence and pattern of childhood cancer in Addis Ababa, Ethiopia (2012-2017). BMC Cancer 2023; 23:1261. [PMID: 38129792 PMCID: PMC10734044 DOI: 10.1186/s12885-023-11765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cancer is becoming a major public health problem globally and a leading cause of death in children in developed countries. However, little is known about the epidemiology of childhood cancer in Ethiopia. This study, therefore, assessed childhood cancer incidence patterns in Addis Ababa using the Addis Ababa city population-based cancer registry data from 2012 to 2017. METHODS Invasive cancer cases diagnosed in ages 0-14 years from 2012 to 2017 were obtained from the Addis Ababa City population-based Cancer Registry. Cases were grouped according to the International Classification of Childhood Cancer, 3rd edition (ICCC-3) based on morphology and primary anatomic site. Age-standardized incidence rates (ASR) were calculated by the direct method using the world standard population. RESULTS The overall average annual incidence rate during 2012-2017 in children was 84.6 cases per million, with rates higher in boys (98.97 per million) than in girls (69.7 per million). By age, incidence rates per million increased from 70.8 cases in ages 0-4 years to 88.4 cases in ages 5-9 years to 110.0 cases 10-14 years. Leukaemia was the most common childhood cancer in both boys (29.1%) and girls (26.8%), followed by lymphoma in boys (24.7%) and renal tumours (13.1%) in girls. The overall cancer incidence rate decreased from 87.02 per million in 2012 to 51.07 per million in 2017. CONCLUSION The burden of childhood cancer is considerably high in Addis Ababa. The observed distribution of childhood cancer in Addis Ababa differs from other African countries. This study highlights the need for further research and understanding of the variations in cancer patterns and risk factors across the region.
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Affiliation(s)
- Amanuel Belay
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ahmed Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eva J Kantelhardt
- Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Chirlaque MD, Peris-Bonet R, Sánchez A, Cruz O, Marcos-Gragera R, Gutiérrez-Ávila G, Quirós-García JR, Almela-Vich F, López de Munain A, Sánchez MJ, Franch-Sureda P, Ardanaz E, Galceran J, Martos C, Salmerón D, Gatta G, Botta L, Cañete A. Childhood and Adolescent Central Nervous System Tumours in Spain: Incidence and Survival over 20 Years: A Historical Baseline for Current Assessment. Cancers (Basel) 2023; 15:5889. [PMID: 38136432 PMCID: PMC10742240 DOI: 10.3390/cancers15245889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) neoplasms are highly frequent solid tumours in children and adolescents. While some studies have shown a rise in their incidence in Europe, others have not. Survival remains limited. We addressed two questions about these tumours in Spain: (1) Is incidence increasing? and (2) Has survival improved? METHODS This population-based study included 1635 children and 328 adolescents from 11 population-based cancer registries with International Classification of Childhood Cancer Group III tumours, incident in 1983-2007. Age-specific and age-standardised (world population) incidence rates (ASRws) were calculated. Incidence time trends were characterised using annual percent change (APC) obtained with Joinpoint. Cases from 1991 to 2005 (1171) were included in Kaplan-Meier survival analyses, and the results were evaluated with log-rank and log-rank for trend tests. Children's survival was age-standardised using: (1) the age distribution of cases and the corresponding trends assessed with Joinpoint; and (2) European weights for comparison with Europe. RESULTS ASRw 1983-2007: children: 32.7 cases/106; adolescents: 23.5 cases/106. The overall incidence of all tumours increased across 1983-2007 in children and adolescents. Considering change points, the APCs were: (1) children: 1983-1993, 4.3%^ (1.1; 7.7); 1993-2007, -0.2% (-1.9; 1.6); (2) adolescents: 1983-2004: 2.9%^ (0.9; 4.9); 2004-2007: -7.7% (-40; 41.9). For malignant tumours, the trends were not significant. 5-year survival was 65% (1991-2005), with no significant trends (except for non-malignant tumours). CONCLUSIONS CNS tumour incidence in Spain was found to be similar to that in Europe. Rises in incidence may be mostly attributable to changes in the registration of non-malignant tumours. The overall malignant CNS tumour trend was compatible with reports for Southern Europe. Survival was lower than in Europe, without improvement over time. We provide a baseline for assessing current paediatric oncology achievements and incidence in respect of childhood and adolescent CNS tumours.
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Affiliation(s)
- Maria D. Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.D.C.); (R.M.-G.); (M.J.S.); (E.A.); (D.S.)
- Department of Epidemiology, Murcia Regional Health Authority, 30071 Murcia, Spain;
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, El Palmar, 30120 Murcia, Spain
| | - Rafael Peris-Bonet
- Spanish Registry of Childhood Tumours (RETI-SEHOP), University of Valencia, Faculty of Medicine, 46010 Valencia, Spain
| | - Antonia Sánchez
- Department of Epidemiology, Murcia Regional Health Authority, 30071 Murcia, Spain;
| | - Ofelia Cruz
- Neuro-Oncology Unit, Paediatric Cancer Centre, Sant Joan de Déu Hospital, Esplugues de Llobregat, 08950 Barcelona, Spain;
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.D.C.); (R.M.-G.); (M.J.S.); (E.A.); (D.S.)
- Epidemiology Unit and Girona Cancer Registry, Oncology Co-Ordination Plan, Catalonian Oncology Institute, 17004 Girona, Spain
- Josep Trueta Girona Biomedical Research Institute (IDIBGI), Salt, 17190 Girona, Spain
- Statistics, Econometrics and Health Research Group (GRECS), University of Girona, 17004 Girona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | | | | | - Fernando Almela-Vich
- Valencian Regional Childhood Cancer Registry, Non-Communicable Disease Epidemiology and Surveillance Department, General Subdirectorate of Epidemiology and Health Surveillance, General Directorate of Public Health and Addictions, Regional Public Health Authority, Valencian Regional Authority, 46010 Valencia, Spain;
| | - Arantza López de Munain
- Basque Country Cancer Registry, Health Department, Basque Country Regional Authority, 01010 Vitoria-Gasteiz, Spain;
| | - Maria J. Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.D.C.); (R.M.-G.); (M.J.S.); (E.A.); (D.S.)
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
- Granada Bio-Health Research Institute, 18012 Granada, Spain
| | - Paula Franch-Sureda
- Mallorca Cancer Registry, General Directorate of Public Health and Participation, Balearic Isles Health Research Institute (IdISBa), 07010 Palma de Mallorca, Spain;
| | - Eva Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.D.C.); (R.M.-G.); (M.J.S.); (E.A.); (D.S.)
- Navarre Public Health Institute, 31003 Pamplona, Spain
- IdiSNA, Navarre Health Research Institute, 31008 Pamplona, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Sant Joan de Reus University Teaching Hospital, 43204 Reus, Spain;
- Pere Virgili Health Research Institute (IISPV), 43204 Reus, Spain
- Faculty of Medicine and Health Sciences, Rovira i Virgili University (URV), 43003 Reus, Spain
| | - Carmen Martos
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain;
| | - Diego Salmerón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.D.C.); (R.M.-G.); (M.J.S.); (E.A.); (D.S.)
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, El Palmar, 30120 Murcia, Spain
- Department of Health and Social Sciences, University of Murcia, 30100 Murcia, Spain
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (G.G.); (L.B.)
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (G.G.); (L.B.)
| | - Adela Cañete
- Spanish Registry of Childhood Tumours (RETI-SEHOP), University of Valencia, Faculty of Medicine, 46010 Valencia, Spain
- Paediatric Oncology Department, La Fe Hospital, 46026 Valencia, Spain
- Paediatrics, Obstetrics and Gynaecology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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Herdell V, Lassarén P, Boop FA, Bartek J, Uche EO, Tisell M. Surgical outcomes of pediatric brain tumors in Sub-Saharan Africa: A systematic review. BRAIN & SPINE 2022; 2:100912. [PMID: 36248098 PMCID: PMC9560713 DOI: 10.1016/j.bas.2022.100912] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022]
Abstract
Background Pediatric Brain Tumors (PBT) are a common cause of cancer-related mortality globally. Contrary to high-income countries (HIC), survival rates in low-and-middle income countries (LMIC) remains low despite advances in neurosurgical care and diagnostics over the past decades. The aim of this systematic review was to investigate the surgical outcomes for PBT in Sub-Saharan Africa, and the distribution of PBT types. Methods A systematic review was conducted on PubMed, for all available literature on the surgical outcomes of PBT in Sub-Saharan Africa, published before May 3, 2022. Two reviewers performed abstract, full text screening and data collection independently, resolving any conflicts by consensus. Results The search yielded 256 studies, of which 22 met the inclusion criteria, amounting to a total of 243 patients. Nigeria was the country with most data. Only subgroups of patients could be extracted from 12 studies, and variables of interest in 6 studies had inconsistent sample sizes. The age centered around 9 years, and there were approximately equal number of girls and boys. The most common tumor was medulloblastoma, followed by craniopharyngioma and astrocytoma. There was large heterogeneity in the reporting of outcomes, and a trend was difficult to discern, considering the large number of different tumor types and different extents of resection. Discussion and conclusion Data is insufficient and inconsistent, precluding statistical conclusions. There is a need for more studies in the field.
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Affiliation(s)
| | | | - Frederick A. Boop
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Section of Neurosurgery, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Enoch O. Uche
- Division of Neurosurgery, Department of Surgery, University of Nigeria Nsukka, Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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