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Al-Nassan A, Almanaseer T, Malkawi S, Al-Bitar F, Jibrin D, El-Qurnah O, Bataineh S, Kamal M, Sweidan S, Abu-Shanab M, Sultan I. Understanding Diagnosis Delay in Children With Cancer: Evidence From a Single Institution in Jordan. J Pediatr Hematol Oncol 2024; 46:e508-e514. [PMID: 39141785 DOI: 10.1097/mph.0000000000002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/18/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND This study aimed to evaluate the factors associated with diagnosis delay in children with cancer who are treated at a single institution, which caters to most children with cancer in Jordan. METHODS This was a cross-sectional study with a retrospective chart review of selected patients who were diagnosed from August 2018 to December 2021. Data on patient and household characteristics, medical history, and diagnostic delay were collected through structured interviews. Univariable and multivariable linear and logistic regression models were used to identify predictors of delay. RESULTS The study included a cohort of 202 patient-caregiver pairs, with a median total delay from symptom onset to treatment initiation of 47 days (interquartile range [IQR], 21 to 114 d). Notably, 86% of families pursued medical consultation within a month of recognizing symptoms. A regression model revealed CNS tumors as a significant independent predictor of increased total delay ( P =0.002), with affected patients experiencing a median delay markedly longer than those with other cancer types. In addition, older patient age predicted longer total delay ( P =0.025). Symptomatology played a pivotal role in the timeliness of the diagnosis; specifically, visible symptoms such as pallor, bruises, and jaundice were associated with more expedient medical attention, with significantly shorter delays ( P values: 0.011, <0.001, and 0.045, respectively). Furthermore, our investigation disclosed a notable variance in symptom prevalence across different cancer categories, elucidating the complex relationship between clinical presentation and diagnostic timelines. CONCLUSIONS This study highlights the importance of the diagnosis of CNS tumors, patient age, and symptoms in predicting diagnosis delay in pediatric oncology patients. These findings can inform interventions to reduce delays in diagnosis and improve outcomes for these patients. These insights are crucial for developing targeted educational programs aimed at healthcare professionals and families to accelerate the recognition and referral of pediatric cancer cases.
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Affiliation(s)
| | | | - Saja Malkawi
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | | | - Dayana Jibrin
- Department of Pediatrics, King Hussein Cancer Center
| | | | - Shaima Bataineh
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Maen Kamal
- Department of Pediatrics, Hurley Medical Center, MI
| | | | | | - Iyad Sultan
- Department of Pediatrics, King Hussein Cancer Center
- Department of Pediatrics, University of Jordan, Amman, Jordan
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Farrag A, Alqudimat MR, Hassan FAA. Family strategies for managing childhood cancer: Using traditional and complementary medicine in Southern Egypt. Pediatr Blood Cancer 2024:e31326. [PMID: 39289855 DOI: 10.1002/pbc.31326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/24/2024] [Accepted: 09/02/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND PURPOSE The use of traditional and complementary medicine (T&CM) is common in children with cancer globally. We aimed to assess the prevalence, types, reasons, perceived effectiveness, and disclosure rate of T&CM use among children with cancer in Southern Egypt. We also investigated whether T&CM use contributed to delays in initial presentation and treatment. MATERIALS AND METHODS A cross-sectional design was utilized. Data were collected via an interviewer-administered questionnaire. Eligible children and their caregivers at the South Egypt Cancer Institute were invited to participate. RESULTS Eighty-six children completed the study (response rate = 86%). T&CM use was reported by 52 (60.5%) patients, with six (11.5%) experienced delayed presentation. The reasons for T&CM use were complementary for 37 (71%) and alternative for 15 (29%) of the participants. The types of T&CM used included herbal (63%), nutritional (33%), witchcraft (29%), and religious (19%) therapies. Approximately 48% of users employed multiple T&CM types. Family members recommended T&CM for 60% of the users. Most patients (65%) perceived T&CM as effective, with 71% initiating its use during the early phases of treatment. Almost all participants (98%) reported that healthcare providers did not inquire about T&CM use. T&CM usage was more prevalent among wealthier families (p = .023). There was no significant relationship between T&CM use and patient gender, diagnosis, residence, or paternal educational level. CONCLUSIONS The significant utilization of T&CM among children with cancer highlights the need for healthcare providers to engage in open and early discussions with families regarding T&CM use.
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Affiliation(s)
- Ahmed Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Children's Hospital of Central Switzerland, Lucerne, Switzerland
| | - Mohammad R Alqudimat
- College of Health Sciences, American University of the Middle East, Kuwait, Kuwait
| | - Fatma A A Hassan
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Irshad HA, Shariq SF, Khan MAA, Shaikh T, Kakar WG, Shakir M, Hankinson TC, Enam SA. Delay in the Diagnosis of Pediatric Brain Tumors in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01274. [PMID: 38984834 DOI: 10.1227/neu.0000000000003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Vague symptoms and a lack of pathognomonic features hinder the timely diagnosis of pediatric brain tumors (PBTs). However, patients in low- and middle-income countries (LMICs) must also bear the brunt of a multitude of additional factors contributing to diagnostic delays and subsequently affecting survival. Therefore, this study aims to assess these factors and quantify the durations associated with diagnostic delays for PBTs in LMICs. METHODS A systematic review of extant literature regarding children from LMICs diagnosed with brain tumors was conducted. Articles published before June 2023 were identified using PubMed, Google Scholar, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. A meta-analysis was conducted using a random-effects model through R Statistical Software. Quality was assessed using the Newcastle Ottawa Scale. RESULTS A total of 40 studies including 2483 patients with PBT from 21 LMICs were identified. Overall, nonspecific symptoms (62.5%) and socioeconomic status (45.0%) were the most frequently reported factors contributing to diagnostic delays. Potential sources of patient-associated delay included lack of parental awareness (45.0%) and financial constraints (42.5%). Factors contributing to health care system delays included misdiagnoses (42.5%) and improper referrals (32.5%). A pooled mean prediagnostic symptomatic interval was calculated to be 230.77 days (127.58-333.96), the patient-associated delay was 146.02 days (16.47-275.57), and the health care system delay was 225.05 days (-64.79 to 514.89). CONCLUSION A multitude of factors contribute to diagnostic delays in LMICs. The disproportionate effect of these factors is demonstrated by the long interval between symptom onset and the definitive diagnosis of PBTs in LMICs, when compared with high-income countries. While evidence-based policy recommendations may improve the pace of diagnosis, policy makers will need to be cognizant of the unique challenges patients and health care systems face in LMICs.
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Affiliation(s)
| | | | | | - Taha Shaikh
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Todd C Hankinson
- Department of Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Wang J, Zhen X, Coyte PC, Shao D, Zhao N, Chang L, Feng Y, Sun X. Association Between Online Health Information-Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China. J Med Internet Res 2023; 25:e46953. [PMID: 37585244 PMCID: PMC10468701 DOI: 10.2196/46953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information-seeking (OHIS) behaviors by caregivers. OBJECTIVE This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. METHODS This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. RESULTS A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. CONCLUSIONS Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact.
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Affiliation(s)
- Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Ni Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Lele Chang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
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Sari NM, Devansyah S, Modjaningrat I, Suryawan N, Susanah S, Rakhmillah L, Wahyudi K, Kaspers GJL. Type of cancer and complementary and alternative medicine are determinant factors for the patient delay experienced by children with cancer: A study in West Java, Indonesia. Pediatr Blood Cancer 2023; 70:e30192. [PMID: 36636790 DOI: 10.1002/pbc.30192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice-associated risk factor to patient delay. METHODS This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi-structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. RESULTS We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6-46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14-126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79-9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13-3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health-seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. CONCLUSION Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.
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Affiliation(s)
- Nur Melani Sari
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Sultan Devansyah
- Universitas Padjadjaran, Faculty of Medicine, Bandung, Indonesia
| | | | - Nur Suryawan
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Susi Susanah
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Lulu Rakhmillah
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Kurnia Wahyudi
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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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.
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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
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Roy Chowdhury S, Bohara AK. Preferences of cancer patients as a guide to cancer prevention: a retrospective willingness to pay study in Nepal. Public Health 2023; 214:42-49. [PMID: 36495725 DOI: 10.1016/j.puhe.2022.10.022] [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: 03/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In developing countries, like Nepal, with no population-based cancer registry and low level of awareness, it is difficult to communicate the significance of cancer preventative measures to the general population. Only patients, who have faced or facing the economic and mental burden of cancer, can better understand the importance of early diagnosis. This led us to study the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program in Nepal. STUDY DESIGN This is a primary survey-based study of 600 diagnosed cancer patients (aged 18+ years) randomly sampled from five hospitals of Nepal during December 2015-February 2016. METHODS Using the contingent valuation estimation methods, we modelled patients' willingness to pay (WTP) for early cancer screening through the Structural Equation Modelling framework. RESULTS About 59% of our sampled patients did not receive education and 65% earned below $100/month. Among other findings, we saw that the Risk of re-occurrence impacted WTP through two opposing channels. The direct effect of Risk of re-occurrence on WTP was positive (β = 0.20; p < 0.05), but higher the risk of cancer relapses, the higher was the Pessimism among patients, which indirectly impacted WTP negatively (β = -0.16; p < 0.1). In addition, we found the effect of Income on WTP to be positive (β = 0.15; p < 0.05), whereas, one belonging to the backward Dalit section of the society had lower WTP for screening. CONCLUSION Cancer patients value the importance of early diagnosis with multiple psychosocial factors impacting this preference. This direct account of patients could be used as evidence in policymaking.
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Affiliation(s)
| | - A K Bohara
- Department of Economics, University of New Mexico, Albuquerque, USA.
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Dewi SP, Gondhowiardjo SA, Mangunatmadja I, Aman RA, Kodrat H, Permata TBM, Handoko. Quality of life in children with brain tumors post radiotherapy in a lower-middle income country. Pediatr Hematol Oncol 2022; 40:597-606. [PMID: 36445236 DOI: 10.1080/08880018.2022.2144559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 12/02/2022]
Abstract
Indonesia is a rapidly growing lower-middle-income country (LMIC) located in Southeast Asia. It has 267.3 million inhabitants, with 31.6% (84.4 million) children. According to GLOBOCAN 2020, Indonesia had the highest prevalence of pediatric cancer cases in Southeast Asia (43.5%), and brain tumors had the third-highest incidence in Indonesia. Treating children with brain tumors with radiotherapy is challenging, especially the late treatment effects that can affect their quality of life (QoL). This study aimed to show the QoL in children with brain tumors after radiotherapy in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, based on PedsQL™ 4.0 generic core scale and the possible affecting factors. In this cross-sectional study, 26 of 88 children with brain tumors after radiotherapy were assessed by the PedsQL™ 4.0 generic core scale. Of the 88 patients who had brain tumor radiotherapy in 2014-2019, 31 patients were lost to follow-up, 28 were confirmed dead, and 29 were assured alive. One-year, three-year, and five-year overall survival were 71.6%, 43.2%, and 5.7%, respectively. The mean of children's QoL was 70.686 and 70.152 based on child self-report and parent proxy-report. Family income > 290 USD (regional minimum wage) was a factor that improved the QoL in children with brain tumors after radiotherapy (p = 0.008). QoL in children with brain tumors after radiotherapy could be influenced by family income.
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Affiliation(s)
- Sinta Prastiana Dewi
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Soehartati A Gondhowiardjo
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Irawan Mangunatmadja
- Department of Pediatrics, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Renindra A Aman
- Department of Neurosurgery, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Henry Kodrat
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - T B Mayang Permata
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Handoko
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Sutaryo S, Widjajanto PH, Mulatsih S, Ardianto B, Pangarso AWS, Supriyadi E, Purwanto I, Adelin CP, Lestari RP, Sagoro L, Christian SD, Sabrina DS, Verena N, Kors WA, Kaspers GJL, Veerman AJP. Childhood acute lymphoblastic leukemia: Four years evaluation of protocols 2013 and 2016 in a single center in Indonesia, a lower-middle-income country. Pediatr Blood Cancer 2022; 69:e29875. [PMID: 35856702 DOI: 10.1002/pbc.29875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognosis of childhood acute lymphoblastic leukemia (ALL) in Indonesia, a lower-middle-income country (LMIC), is lower than in high income countries (HICs). The Indonesian ALL2013 protocol resulted in too many toxic deaths (21%) and abandonments (11%). Therefore, we drafted an adapted protocol, ALL2016. Main changes: no anthracyclines in standard risk (SR), prednisone replaced dexamethasone at induction in high risk (HR), and anthracyclines and cyclophosphamide were rescheduled in HR. PROCEDURE Patients (aged: 1-18 years) were stratified into SR and HR. HR was defined as age over 10 years, leucocyte count over 50 × 109 /L, central nervous system (CNS) involvement, mediastinal mass, T-cell phenotype, testicular involvement, or poor prednisone response. RESULTS ALL2013 included 174 patients (106 SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). Although the number of HR patients was significantly higher in ALL2016 (51.6% vs. 39.1%; p = .017), the outcome of ALL2016 improved over ALL2013 (4-year-probable overall survival (pOS) 60.1% vs. 50.0%; p = .042 and 4-year-probable event-free survival (pEFS) 49.5% vs. 36.8%; p = .018). ALL2016 showed a nonsignificant advantage for SR patients (4-year-pEFS 56.0% vs. 47.2%; p = .220 and 4-year-pOS 70.3% vs. 61.3%; p = .166), but less toxic deaths (7% vs. 20%; p = .011). In HR group, the outcomes were significantly better in ALL2016 (4-year-pEFS 43.3% vs. 20.6%; p = .004; 4-year-pOS 50.5% vs. 32.4%; p = .014) especially due to less relapses (31% vs. 62%; p = .001). Isolated CNS relapses went down from 18 to 8% in HR (p = .010) and 11 to 5% in SR (p = .474). Both SR and HR showed lower numbers of abandonment in ALL2016 (6% vs. 14%; p = .039). CONCLUSIONS Overall ALL2016 results improved over ALL2013. Modest changes in protocol resulted in less initial toxicity and abandonments.
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Affiliation(s)
- Sutaryo Sutaryo
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Bambang Ardianto
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Eddy Supriyadi
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Ignatius Purwanto
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Claudia Priska Adelin
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Rahmadani Puji Lestari
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Lintang Sagoro
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Scholastika Dita Christian
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Dea Sella Sabrina
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Natasha Verena
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Wijnanda Adriana Kors
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia.,Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia.,Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anjo J P Veerman
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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Maryam D, Wu LM, Su YC, Hsu MT, Harianto S. The journey of embracing life: Mothers' perspectives of living with their children with retinoblastoma. J Pediatr Nurs 2022; 66:e46-e53. [PMID: 35718669 DOI: 10.1016/j.pedn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to explore the experience and views of mothers with children who have been diagnosed with retinoblastoma. DESIGN AND METHODS A descriptive qualitative study was conducted in the period of 2019-2021. Interviews were conducted with 21 mothers of children diagnosed with retinoblastoma in Indonesia. Data were collected by semi-structured interviews and examined by content analysis. RESULTS Mothers evolved from a sense of unacceptability to accepting challenges and gaining inner strength. Three themes were identified: 1) physical and psychological suffering, 2) awareness of changes and demands, and 3) keep moving forward. Mothers developed positive adaptive mechanisms for coping with the problems associated with having a child with retinoblastoma. Psychological adjustment and religious beliefs were key elements in their journeys toward embracing life in the moment. CONCLUSION Findings illuminated psychological adaptation and coping strategies of mothers with seriously ill children and highlighted how difficulties and cultural norms shaped the adaptative process. Religion and health beliefs played varied and important roles in helping mothers to manage their stress and enhance their coping strategies. PRACTICE IMPLICATIONS Our findings revealed that it is important to routinely assess social support, traditional health beliefs, and spirituality on mothers, facilitate mentoring to help mothers find their inner strengths, and develop intervention programs designed to promote psychological adjustment without delaying treatment.
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Affiliation(s)
- Dewi Maryam
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC, and Dr Soetomo Hospital, Surabaya, Indonesia.
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, and Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
| | - Yi-Ching Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Min-Tao Hsu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Susilo Harianto
- Faculty of Nursing, Airlangga University, Surabaya Indonesia, Faculty of Vocational, Airlangga Indonesia, Mulyorejo, Surabaya 60115, Indonesia.
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11
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Ocak S, Sen HS, Turkkan E. The time to diagnosis and survival in children with solid tumors and lymphoma: results from a single center in Turkey. Pediatr Hematol Oncol 2022; 39:121-131. [PMID: 34281453 DOI: 10.1080/08880018.2021.1951903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The longer diagnostic intervals in low- and middle-income countries have been proposed among the possible causes of poorer outcomes in children with cancer. In this single-center study from Turkey, the diagnostic intervals and survival status of 138 children with solid tumors and lymphoma (excluding leukemia) were prospectively evaluated. The median total interval (from the beginning of the first cancer-related symptom to the first day of the cancer-specific therapy), the median patient interval (the time interval from the notification of the first cancer-related symptom to the first admission to a healthcare facility), and the median physician interval (the time interval between the first healthcare admission to the first pediatric oncology visit) were 65, 26, and 24 days, respectively. The estimated 5-year overall survival and event-free survival rates were 80.7% and 69.1%, respectively. The longer time intervals were correlated with age, paternal education, localization, and tumor type. Interestingly, none of the time parameters were found to be associated with survival on regression analysis. In conclusion, the diagnostic delay in children with cancer is multifactorial, and the patient- and disease-related factors are as important as the time intervals on survival.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.1951903.
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Affiliation(s)
- Suheyla Ocak
- Department of Pediatric Hematology-Oncology, Ministry of Health Okmeydani Training and Research Hospital, Istanbul, Turkey.,Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hilal Susam Sen
- Department of Pediatric Hematology-Oncology, Ministry of Health Okmeydani Training and Research Hospital, Istanbul, Turkey.,Department of Pediatric Hematology-Oncology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Istanbul, Turkey
| | - Emine Turkkan
- Department of Pediatric Hematology-Oncology, Ministry of Health Okmeydani Training and Research Hospital, Istanbul, Turkey
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12
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Qualificação profissional e o câncer infantojuvenil na atenção básica. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Handayani K, Susilawati D, Sutaryo, Mulatsih S, Kaspers GJL, Mostert S, Sitaresmi M. Health-care providers’ perception and communication about traditional and complementary medicine in childhood cancer in Indonesia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Mullen CJR, Barr RD, Franco EL. Timeliness of diagnosis and treatment: the challenge of childhood cancers. Br J Cancer 2021; 125:1612-1620. [PMID: 34471259 PMCID: PMC8651632 DOI: 10.1038/s41416-021-01533-4] [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: 04/20/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation 'delay in diagnosis and treatment' is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum.
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Affiliation(s)
- Callum J R Mullen
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada.
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15
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Handayani K, Indraswari BW, Sitaresmi MN, Mulatsih S, Widjajanto PH, Kors WA, Kaspers GJ, Mostert S. Treatment Outcome of Children with Retinoblastoma in a Tertiary Care Referral Hospital in Indonesia. Asian Pac J Cancer Prev 2021; 22:1613-1621. [PMID: 34048193 PMCID: PMC8408394 DOI: 10.31557/apjcp.2021.22.5.1613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Although survival rates for retinoblastoma (RB) are over 95% in high-income countries, its high mortality rate in low and middle-income countries remains a great concern. Few studies investigated treatment outcome and factors contributing to RB survival in these latter settings. Aims of this study are to determine treatment outcome of Indonesian children diagnosed with RB and to explore factors predictive of treatment outcome. Methods: This study was a retrospective medical records review combined with an illustrative case report. Children newly diagnosed with RB between January 2011 and December 2016 at a tertiary care referral hospital in Indonesia were included. A home visit was conducted to perform an in-depth interview with a mother of two children affected by RB. Results: Of all 61 children with RB, 39% abandoned treatment, 21% died, 20% had progressive or relapsed disease and 20% event-free survival. Progressive or relapsed disease was more common in older (≥ 2 years at diagnosis, 29%) than young (<2 years at diagnosis, 0%) children (P=0.012). Event-free survival estimate at 5 years was higher in young (42%) than older (6%) children (P=0.045). Odds-ratio for event-free survival was 6.9 (95% CI: 1.747 – 27.328, P=0.006) for young versus older children. Other clinical and socio-demographic characteristics had no significant correlation with treatment outcome or event-free survival. The case report elucidated conditions and obstacles that Indonesian families face when their children are diagnosed with RB. Conclusion: Survival of children with RB in Indonesia is much lower compared to high-income and many other low and middle-income countries. Abandonment of treatment is the most common cause of treatment failure. Older age at diagnosis is associated with more progressive or relapsed disease and worse survival. Interventions to improve general public and health-care providers’ awareness, early detection and treatment adherence are required.
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Affiliation(s)
- Krisna Handayani
- Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, the Netherlands
| | - Braghmandita W Indraswari
- Pediatrics, Faculty Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Mei N Sitaresmi
- Pediatrics, Faculty Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Pediatrics, Faculty Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo H Widjajanto
- Pediatrics, Faculty Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Wijnanda A Kors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gertjan Jl Kaspers
- Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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16
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Widayanti AW, Green JA, Heydon S, Norris P. Health-Seeking Behavior of People in Indonesia: A Narrative Review. J Epidemiol Glob Health 2021; 10:6-15. [PMID: 32175705 PMCID: PMC7310809 DOI: 10.2991/jegh.k.200102.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/21/2019] [Indexed: 11/01/2022] Open
Abstract
This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.
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Affiliation(s)
- Anna Wahyuni Widayanti
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Allied Health and Physical Activity for Health, Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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17
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Couitchéré L, Coze C, Atiméré YN, Ouattara J, N'doumy M, Akoun C, Yao GC, Cissé L. [Impact of an early diagnosis program for childhood cancer in Abidjan?]. Bull Cancer 2021; 108:242-249. [PMID: 33648719 DOI: 10.1016/j.bulcan.2020.11.013] [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: 06/09/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To promote the early diagnosis of pediatric cancers in Ivory Coast, we have initiated a program to train local physicians in the warning signs and to raise public awareness. The aim of this work was to compare the times, stages and survival of patients before and three years after the initiation of the program. METHODS This retrospective study involved children 0-17 years of age admitted from January to December 2014 and from May 2018 to April 2019. The Mann-Whitney non-parametric test and the Fisher's exact test were used to compare time limits, stages and survival. RESULTS One hundred and fifty-nine doctors were trained and 1020 people were sensitized. The median age of the 216 children included was 7 years, sex ratio 1.4. For both periods, the median consultation times were 75 and 30 days (P=0.003) and the median diagnostic times were 120 and 105 days (P=0.033). High-risk lymphomas accounted for 60.5% and 58.5% (P=0.99) respectively and nephroblastoma 46.1% and 56.2% (P=0.51). The overall survival was 31% and 30.2% (P=0.92). DISCUSSION The early diagnosis program had no impact. The diagnosis times and the proportion of cancer classified as high risk are comparable to the data reported in sub-Saharan Africa, which vary respectively from 7 to 15.8 weeks and from 60 to 71%. This program must be intensified, extended to all health workers and include improving access to care.
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Affiliation(s)
- Line Couitchéré
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire.
| | - Carole Coze
- Hôpital Enfants de la Timone, service d'oncologie et hématologie pédiatrique, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Yao Nicaise Atiméré
- Centre Hospitalier Universitaire de Treichville, Service d'Hématologie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
| | - Joseph Ouattara
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
| | - Max N'doumy
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
| | - Charles Akoun
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
| | - Guy Constant Yao
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
| | - Lacina Cissé
- Centre Hospitalier Universitaire de Treichville, Service de Pédiatrie, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire
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18
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Verma N, Bhattacharya S. Time to Diagnosis and Treatment of Childhood Cancer. Indian J Pediatr 2020; 87:641-643. [PMID: 32056193 DOI: 10.1007/s12098-020-03217-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
Outcome of childhood cancer in low middle-income countries continues to be poor. One of the proposed reasons for this poor outcome is increased time spent in diagnosis and initiation of treatment. The present study was done to quantify the magnitude and types of time intervals in management of childhood cancer. Parents of 111 children with newly diagnosed cancer were interviewed. Median total time interval for entire cohort was 58 d. The most important contributor to this total interval was Referral interval. Gender and use of alternative medicine significantly affected the total interval. Increased primary care physician sensitization for quicker referral to specialized centers may mitigate the delay and improve outcome.
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Affiliation(s)
- Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Sudipto Bhattacharya
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
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19
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Barragán-Pérez EJ, Altamirano-Vergara CE, Alvarez-Amado DE, García-Beristain JC, Chico-Ponce-de-León F, González-Carranza V, Juárez-Villegas L, Murata C. The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis. Pathol Oncol Res 2020; 26:2693-2701. [PMID: 32661835 DOI: 10.1007/s12253-020-00875-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.
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Affiliation(s)
| | | | - Daniel Eduardo Alvarez-Amado
- Pediatric Neurology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico. .,Hospital Infantil de México Federico Gómez, Calle Doctor Márquez 162, Alcadía Doctores, Cuauhtémoc, 06720, Ciudad de México, Mexico.
| | | | | | | | - Luis Juárez-Villegas
- Pediatric Oncology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional de Pediatria, Mexico City, Mexico
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20
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Communication about Traditional Complementary and Alternative Medicine (TCAM) in childhood cancer: A comparison between Dutch and Indonesian health-care providers at academic hospitals. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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21
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Carpenter K, Slone AK, Scheuer M, Mehta PS, Slone JS. Factors influencing diagnostic delays of pediatric cancers in Botswana. Pediatr Blood Cancer 2020; 67:e28182. [PMID: 31925921 DOI: 10.1002/pbc.28182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND A major barrier in improving cancer outcomes in Botswana and other low- and middle-income countries is timely access to care. Understanding time to diagnosis of pediatric cancers in Botswana and evaluating factors contributing to delays was necessary to inform interventions. METHODS A retrospective cohort study of children diagnosed with cancer at Princess Marina Hospital from 2008 to 2015 was performed utilizing the Botswana Pediatric Oncology Database. The time to diagnosis, pretreatment center delay, and pathology turnaround time were calculated. Time to diagnosis was analyzed using univariate and multivariate analyses to determine association with age, sex, distance to a treatment center, HIV status, cancer type, outcome, and presence of metastasis at diagnosis. RESULTS The median time to diagnosis was 10.7 weeks, median pretreatment center delay was 9.6 weeks, and median pathology turnaround time was 3 weeks. Longer time to diagnosis was significantly correlated with presence of metastasis at diagnosis. Age, sex, distance to a treatment center, HIV status, cancer type, and outcome were not significantly associated with diagnostic delay. CONCLUSION Children with cancer in Botswana have more than three months of symptoms prior to diagnosis, which is associated with metastasis at diagnosis. Efforts should be made to empower and promote awareness of pediatric cancer symptoms among caregivers and community healthcare providers in order to shorten time to presentation at a treatment center.
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Affiliation(s)
- Kendall Carpenter
- Princeton in Africa Fellowship, Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | | | - Michael Scheuer
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Parth S Mehta
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Jeremy S Slone
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
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22
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Challinor JM, Day SW, Afungchwi GM, Alqudimat MR. Pediatric Oncology Nursing Research in Low- and Middle-Income Countries. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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23
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Abstract
The diagnosis of cancer in a child leaves parents and families devastated and vulnerable. In an effort to do everything possible, families often choose an integrative medicine approach to their child's care. Surveys have found that 31%-84% of children with cancer use complementary and alternative medicine and most often as supportive care agents. Several systematic reviews have demonstrated a clinical benefit for some select therapies; however, the safety and efficacy of the combination of biological therapies with conventional treatment remain largely unknown and garner concern due to the potential for interactions with conventional therapy. Given the sustained use and potential benefit of integrative medicine, additional research is warranted in pediatric oncology. Utilizing the available literature, clinical providers should aim to conduct open and nonjudgmental discussions with families about the use of integrative medicine so as to guide the safe integration of the two modalities.
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Affiliation(s)
- Elena J Ladas
- Department of Pediatrics, Division of Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center , New York, New York
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24
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Tapela NM, Peluso MJ, Kohler RE, Setlhako II, Botebele K, Gabegwe K, Nkele I, Narasimhamurthy M, Mmalane M, Grover S, Barak T, Shulman LN, Lockman S, Dryden-Peterson S. A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana. Front Oncol 2018; 8:187. [PMID: 29896450 PMCID: PMC5986942 DOI: 10.3389/fonc.2018.00187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59-653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers. Methods Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants' performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants' satisfaction with the program was measured on a separate survey using a 5-point Likert scale. Results 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2-18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program's content and its relevance to their daily work. Conclusion We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02752061.
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Affiliation(s)
- Neo M Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Michael J Peluso
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Racquel E Kohler
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Irene I Setlhako
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Kemiso Gabegwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Isaac Nkele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mohan Narasimhamurthy
- Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA, United States.,Botswana Upenn Partnership, Gaborone, Botswana
| | - Tomer Barak
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
| | - Scott Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
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A systematic review of integrative clinical trials for supportive care in pediatric oncology: a report from the International Society of Pediatric Oncology, T&CM collaborative. Support Care Cancer 2017; 26:375-391. [PMID: 29026997 DOI: 10.1007/s00520-017-3908-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Traditional and complementary medicine (T&CM) use in children with cancer is well established among high-income, upper middle-income, low-middle-income, and low-income countries (HIC, UMIC, LMIC, LIC, respectively). In HIC, a developing body of evidence exists for several T&CM therapies; however, evidence in other income settings is less well described despite a significantly higher use when compared to reports from HIC. The aim of this systematic review was to evaluate the evidence for T&CM for a variety of supportive care indications among children with cancer. METHODS We performed a systematic review following the PRISMA guidelines of randomized, controlled clinical trials from inception through September 2016. Our eligibility criteria were limited to T&CM studies performed in children and adolescents undergoing treatment for a pediatric malignancy. RESULTS Of 6342 studies identified, 44 met inclusion criteria. Two clinical trials reported on acupuncture, 1 reported on aromatherapy, 9 evaluated massage therapy, and 32 reported on dietary supplements. Twenty-two studies were performed in HIC, 15 in UMIC, and 7 in LMIC. T&CM therapies were most commonly investigated for the prevention or management of mucositis, weight loss, and febrile neutropenia. Encouraging results were reported for select interventions; however, the majority of studies were classified as poor to fair quality. CONCLUSION Our search revealed numerous clinical studies investigating the use of T&CM for supportive care purposes in pediatric oncology in HIC, UMIC, and LMIC. Although limited, these results could inform supportive care resource allocation and indicate where T&CM may serve to fill gaps where access to care may be limited.
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