1
|
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
|
2
|
Diagnostic approaches and future directions in Burkitt lymphoma and high-grade B-cell lymphoma. Virchows Arch 2023; 482:193-205. [PMID: 36057749 DOI: 10.1007/s00428-022-03404-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023]
Abstract
Since the 2016 WHO update, progress has been made in understanding the biology of Burkitt lymphoma (BL) and the concept of high-grade B-cell lymphomas (HGBCL) that allows some degree of refinement. The summary presented here reviews in detail the discussions of the Clinical Advisory Committee and expands upon the newly published 2022 International Consensus Classification for lymphoid malignancies (Campo et al. Blood, 2022). BL remains the prototypic HGBCL and diagnostic criteria are largely unchanged. HGBCL with MYC and BCL2 and HGBCL with MYC and BCL6 rearrangements are now separated to reflect biologic and pathologic differences. HGBCL, NOS remains a diagnosis of exclusion that should be used only in rare cases. FISH strategies for diffuse large B-cell lymphoma (DLBCL) and HGBCL are discussed in detail for these diseases. Advances in integrative analysis of mutations, structural abnormalities, copy number, and gene expression signatures allow a more nuanced view of the heterogeneity of DLBCL, NOS as well as definitions of HGBCL and point to where the future may be headed for classification of these diseases.
Collapse
|
3
|
Afungchwi GM, Kruger M, Wharin PD, Bardin R, Kouya FN, Hesseling PB. The Evolution of a Hospital-Based Cancer Registry in Northwest Cameroon from 2004 to 2015. J Trop Pediatr 2021; 67:5918207. [PMID: 33020840 DOI: 10.1093/tropej/fmaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Effective cancer registration is required for the development of cancer management policies, but is often deficient in the developing world. In 2008 cancer registration was set up Banso Baptist Hospital and Mbingo Baptist Hospital in the Northwest region of Cameroon, using the Pediatric Oncology Networked Database (POND). The objective of this study was to analyze the POND registry data for patients with cancer aged 0-15 years for the period 2004-15. A total of 1029 malignancies were recorded in children 0-15 years in the study period. The male-to-female ratio was 1.4:1. The median age at diagnosis was 7.22 years. The most common malignancies were lymphomas followed by nephroblastoma, retinoblastoma, rhabdomyosarcoma and Kaposi sarcoma. There were more Burkitt lymphomas cases between 2004 and 2009 than between 2010 and 2015, while the number of cases rose for other diagnoses like retinoblastoma and nephroblastoma. This report has demonstrated how pediatric oncology registration can be implemented, improved and sustained in a low- and middle-income country setting with limited resources. Using the data, these hospitals can improve their treatment planning and ensure the availability of essential chemotherapy for childhood cancers.
Collapse
Affiliation(s)
- Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, 8000, South Africa.,Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, 00237, Cameroon
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, 8000, South Africa
| | - Paul D Wharin
- Beryl Thyer Memorial Africa Trust, 15 Warkton, 9XF, UK
| | - Richard Bardin
- Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, 00237, Cameroon
| | - Francine N Kouya
- Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, 00237, Cameroon
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, 8000, South Africa
| |
Collapse
|
4
|
Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa. Blood Adv 2021; 4:4007-4019. [PMID: 32841337 DOI: 10.1182/bloodadvances.2020002178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Long-term cure of childhood Burkitt lymphoma (BL) in sub-Saharan Africa after treatment with single-agent cyclophosphamide has been documented for more than half of a century. Contemporary cure rates for the highest-risk patients with BL in high-income countries exceed 90% using intensive multiagent chemotherapy. By contrast, the majority of African children with BL still die. Data spanning 5 decades in Africa have repeatedly shown that the children most likely to achieve cure with limited cyclophosphamide regimens are those with lower-stage disease isolated to the jaw. Attempts to intensify the cyclophosphamide monotherapy backbone with the addition of vincristine, low-dose methotrexate, prednisone, doxorubicin, and/or low-dose cytarabine have not yielded significant improvement. High-dose methotrexate is a critical component in the treatment of childhood BL worldwide. Although initial efforts in Africa to incorporate high-dose methotrexate resulted in high treatment-related mortality, more recent collaborative experiences from North and West Africa, as well as Central America, demonstrate that it can be administered safely and effectively, despite limitations in supportive care resources. Recognizing the unacceptable disparity in curative outcomes for BL between the United States/Europe and equatorial Africa, there is a critical need to safely adapt contemporary treatment regimens to optimize curative outcomes amid the resource limitations in regions where BL is endemic. Here, we critically review reports of BL treatment outcomes from low- and middle-income countries, in addition to data from high-income countries that predated modern intensified regimens, to identify potential strategies to improve the therapeutic approach for children suffering from BL in sub-Saharan Africa.
Collapse
|