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Atwiine B, Mdoka C, Branchard M, Chagaluka G, Fufa D, Ayalew M, Khofi H, Amankwah E, Chokwenda N, Birhane F, Mezgebu E, Eklu B, Jator B, Kudowa E, Mbah G, Wassie M, Dondo V, Paintsil V, Pritchard-Jones K, Renner LA, Sung L, Kouya F, Molyneux E, Chitsike I, Israels T. Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa. Pediatr Blood Cancer 2024; 71:e31069. [PMID: 38773703 DOI: 10.1002/pbc.31069] [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: 02/19/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.
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Affiliation(s)
| | - Cecilia Mdoka
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
| | | | - George Chagaluka
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | - Diriba Fufa
- Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Mulugeta Ayalew
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Harriet Khofi
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | | | | | - Feven Birhane
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | | | - Bernice Eklu
- Paediatric Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Brian Jator
- Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
| | - Evaristar Kudowa
- Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Glenn Mbah
- Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
| | - Mulugeta Wassie
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Vongai Dondo
- Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Vivian Paintsil
- Paediatric Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Lillian Sung
- Sick Children's Hospital, Toronto, Ontario, Canada
| | | | - Elizabeth Molyneux
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | - Inam Chitsike
- Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Trijn Israels
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
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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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Soliman R, Bolous N, Heneghan C, Oke J, Boylan AM, Eweida W, Abouelnaga S, Elhaddad A. An overview of childhood cancer care and outcomes in Egypt: a narrative review. Ecancermedicalscience 2024; 18:1676. [PMID: 38439811 PMCID: PMC10911675 DOI: 10.3332/ecancer.2024.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 03/06/2024] Open
Abstract
Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.
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Affiliation(s)
- Ranin Soliman
- Health Economics and Value Unit, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Centre for Evidence-Based Medicine, University of Oxford, OX1 2JD Oxford, UK
- Co-first authors
| | - Nancy Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Co-first authors
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Anne-Marie Boylan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
| | - Sherif Abouelnaga
- Chief Executive Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- Paediatric Oncology Department, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
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Israels T, Arora RS, Sung L. The value of reporting on end-of-treatment outcome of patients in low-income settings. Pediatr Blood Cancer 2023; 70:e30686. [PMID: 37728943 DOI: 10.1002/pbc.30686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Trijn Israels
- Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Lillian Sung
- Sick Children's Hospital, Toronto, Ontario, Canada
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Salek M, Silverstein A, Tilly A, Gassant PY, Gunasekera S, Hordofa DF, Hesson D, Duffy C, Malik N, McNeil M, Force LM, Bhakta N, Rodin D, Kaye EC. Factors influencing treatment decision-making for cancer patients in low- and middle-income countries: A scoping review. Cancer Med 2023; 12:18133-18152. [PMID: 37526041 PMCID: PMC10524036 DOI: 10.1002/cam4.6375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/01/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE In this scoping review, we evaluated existing literature related to factors influencing treatment decision-making for patients diagnosed with cancer in low- and middle-income countries, noting factors that influence decisions to pursue treatment with curative versus non-curative intent. We identified an existing framework for adult cancer developed in a high-income country (HIC) context and described similar and novel factors relevant to low-and middle-income country settings. METHODS We used scoping review methodology to identify and synthesize existing literature on factors influencing decision-making for pediatric and adult cancer in these settings. Articles were identified through an advanced Boolean search across six databases, inclusive of all article types from inception through July 2022. RESULTS Seventy-nine articles were identified from 22 countries across six regions, primarily reporting the experiences of lower-middle and upper-middle-income countries. Included articles largely represented original research (54%), adult cancer populations (61%), and studied patients as the targeted population (51%). More than a quarter of articles focused exclusively on breast cancer (28%). Approximately 30% described factors that influenced decisions to choose between therapies with curative versus non-curative intent. Of 56 reported factors, 22 novel factors were identified. Socioeconomic status, reimbursement policies/cost of treatment, and treatment and supportive care were the most commonly described factors. CONCLUSIONS This scoping review expanded upon previously described factors that influence cancer treatment decision-making in HICs, broadening knowledge to include perspectives of low- and middle-income countries. While global commonalities exist, certain variables influence treatment choices differently or uniquely in different settings. Treatment regimens should further be tailored to local environments with consideration of contextual factors and accessible resources that often impact decision-making.
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Affiliation(s)
- Marta Salek
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Allison Silverstein
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Alyssa Tilly
- Division of General Medicine and Clinical EpidemiologyUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | | | - Sanjeeva Gunasekera
- Department of Paediatric OncologyNational Cancer InstituteMaharagamaSri Lanka
| | - Diriba Fufa Hordofa
- Department of Pediatrics and Child HealthJimma University Medical CenterJimmaEthiopia
| | - Donna Hesson
- Welch Medical LibraryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Caitlyn Duffy
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nauman Malik
- Department of Radiation OncologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Michael McNeil
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lisa M. Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Danielle Rodin
- Department of Radiation, OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
- Canada Global Cancer ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Erica C. Kaye
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
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Chagaluka G, Afungchwi GM, Landman L, Njuguna F, Hesseling P, Tchintseme F, Sung L, Paintsil V, Molyneux E, Chitsike I, Israels T. Treatment abandonment: A report from the collaborative African network for childhood cancer care and research-CANCaRe Africa. Pediatr Blood Cancer 2021; 68:e29367. [PMID: 34549506 DOI: 10.1002/pbc.29367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low- and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. METHODS A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). CONCLUSIONS Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.
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Affiliation(s)
- George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Glenn Mbah Afungchwi
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lisa Landman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Tchintseme
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - Trijn Israels
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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