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Hesseling PB, Afungchwi GM, Njodzeka BW, Wharin P, Kouya FN, Kruger M. Burkitt lymphoma: The effect of age, sex and delay to diagnosis on treatment completion and outcome of treatment in 934 Patients in Cameroon. PLoS One 2024; 19:e0299777. [PMID: 38466670 PMCID: PMC10927099 DOI: 10.1371/journal.pone.0299777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION The role of age and sex in the presentation and outcome of endemic Burkitt lymphoma (BL) has not been studied recently. This study analysed these factors in 934 patients with BL who had received cyclophosphamide and intrathecal methotrexate as treatment. METHODS Records of 934 children diagnosed with BL from 2004 to 2015 were obtained from our Paediatric Oncology Networked Database (POND) cancer registry. Age at diagnosis, sex, disease stage, time to diagnosis, delay in diagnosis, completion of treatment, rate of abandonment, and one-year survival rates were recorded and statistically analysed. RESULTS The male to female ratio of 1.41 for the study population of 934. The median delay from onset of symptoms to diagnosis was 31 days. The St Jude stage distribution was I = 6.4%, II = 5.9%, III = 71.5% and IV = 16.2%. Significantly more patients presented with stage III disease in age groups 5-9 and 10-14 years than 0-4 years. The overall 1-year survival rate was 53.45%, respectively 77.1% for stage I, 67.9% for stage II, 55.1% for stage III and 32.4% for stage IV disease (p<0.001). There was no significant difference in survival by sex and age group. CONCLUSION Patients aged under 5 years presented with less-advanced disease, but survival was not affected by age. Sex did not influence delay to diagnosis and overall survival. The long delay between the onset of symptoms and diagnosis emphasises the need for interventions to achieve an earlier diagnosis and a better survival rate.
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Affiliation(s)
- Peter Bernard Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Glenn Mbah Afungchwi
- Department of Nursing and Midwifery, The University of Bamenda, Bamenda, Cameroon
| | | | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Burton Latimer, United Kingdom
| | | | - Mariana Kruger
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Lemmen J, Njuguna F, Verhulst S, Vik TA, Ket JCF, Kaspers G, Mostert S. Late Effects of Childhood Cancer Survivors in Africa: a Scoping Review. Crit Rev Oncol Hematol 2023; 185:103981. [PMID: 37003444 DOI: 10.1016/j.critrevonc.2023.103981] [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: 01/31/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The number of children surviving cancer in Africa is increasing. Knowledge about late effects of survivors is lacking. Our study maps literature regarding late effects of childhood cancer survivors in Africa. METHODS Scoping review was performed following JBI-guidelines. Systematic literature search was conducted in: Medline, Embase, African Index Medicus, Web of Science, Scopus, Psycinfo. Titles and abstracts were screened by two reviewers, followed by full-text analysis by the lead reviewer. RESULTS Sixty-eight studies were included for content analysis. Studies originated from 10 of 54 African countries. Most studies had retrospective study design, 2-5 years follow-up, solely chemotherapy as treatment modality, Egypt as country of origin. Fifty-three studies described physical, and seventeen studies described psychosocial late effects. CONCLUSION Literature concerning late effects is available from a limited number of African countries. Psychosocial domain lacks attention compared to the physical domain. More countries should report on this topic to prevent, identify and monitor late effects.
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Affiliation(s)
- Jesse Lemmen
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Sanne Verhulst
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands
| | - Terry A Vik
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States of America
| | | | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
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Kruger M, van Elsland SL, Afungchwi GM, Bardin R, Njodzeka B, Kouya F, Nfor P, Nana P, Wharin P, Hesseling PB. Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting. Pediatr Blood Cancer 2022; 69:e29642. [PMID: 35403812 DOI: 10.1002/pbc.29642] [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: 07/20/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.,Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Richard Bardin
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Bernard Njodzeka
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Patience Nfor
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Philippa Nana
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Warkton, UK
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Moleti ML, Testi AM, Foà R. Childhood aggressive B-cell non-Hodgkin lymphoma in low-middle-income countries. Br J Haematol 2021; 196:849-863. [PMID: 34866182 DOI: 10.1111/bjh.17979] [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: 10/11/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
In high-income countries (HICs) paediatric aggressive B-cell lymphomas are curable in about 90% of cases. Much worse results, with cure rates ranging from less than 30% to about 70%, are achieved in low- and middle-income countries (LMICs), where 90% of paediatric non-Hodgkin lymphomas occur. Low socio-economic and cultural conditions, the lack of optimal diagnostic procedures, laboratory facilities and adequate supportive care exert a strong negative impact on compliance, treatment delivery, toxicity and, consequently, on the clinical outcome. Published data are scarce, generally originating from single institutions, and are difficult to compare. National and international cooperation projects have been undertaken to reduce the unacceptable gap between HICs and LMICs in the management of children with cancer, by promoting the sharing of knowledge and by implementing adequate local healthcare facilities, with initial promising results. In the present review, we will summarize the results so far obtained in the management of paediatric aggressive B-cell NHL in LMICs.
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Affiliation(s)
- Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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Afungchwi GM, Kruger M, Kouya F, Tih P, McCormick P, Pondy-Ongotsoyi AH, Hesseling PB. Two decades of childhood cancer care in Cameroon: 2000-2020. Pediatr Blood Cancer 2021; 68:e28997. [PMID: 33719184 DOI: 10.1002/pbc.28997] [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] [Received: 10/13/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Before the year 2000, there was no dedicated childhood cancer service in Cameroon. The aim of this study was to investigate the progress made with pediatric oncology care in Cameroon from 2000 to 2020. METHOD A literature search was conducted for published articles on childhood cancer in Cameroon and relevant documents, and conference abstracts were reviewed. The articles were analyzed under the themes: awareness, diagnosis, epidemiology, treatment, outcome, advocacy, partnerships, traditional and complementary medicine, palliative care, and capacity building. RESULTS Low awareness on childhood cancer was addressed with education activities targeting the general population and health care professionals. Cancer diagnosis was achieved with cytology, histology, and simple imaging. Management for common and curable cancers was implemented with use of modified treatment regimens for low- and middle-income settings. Nutritional support was shown to mitigate the effects of malnutrition on treatment toxicity, and support was provided for transportation and accommodation. There was good collaboration between the pediatric oncology professionals nationally and twinning with international partners. Capacity building activities led to the availability of three pediatric oncologists and pediatric oncology-trained nurses. Advocacy nationally led to the support of the Ministry of Health with pediatric oncology-specific priority actions in the latest national cancer control plan. CONCLUSION Childhood cancer should receive the necessary attention of health care policymakers in Cameroon. With continued commitment of government, nongovernmental organizations, charities, childhood cancer specialists, patient and parent groups, there should be an improved future for children with cancer in Cameroon.
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Affiliation(s)
- Glenn Mbah Afungchwi
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon.,Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Pius Tih
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | | | - Angele-Hermine Pondy-Ongotsoyi
- Pediatric Hematology/Oncology, Mother and Child Center, Chantal Biya Foundation, Yaounde, Cameroon.,Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Peter B Hesseling
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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