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Sanga ES, Mbata DD, Msoka EF, Mchome Z, Karia FP, Pollak KI, Robles JM, Schroeder K. The socio-cultural contexts shaping health-seeking behaviours among community members regarding childhood cancer in Tanzania: A qualitative study. Pediatr Blood Cancer 2024; 71:e31278. [PMID: 39238136 DOI: 10.1002/pbc.31278] [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: 10/02/2023] [Revised: 07/03/2024] [Accepted: 08/06/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Timely diagnosis of childhood cancer, early hospital presentation and completion of treatment significantly improve outcomes. Unfortunately, in Tanzania, thousands of children die of cancer each year without ever being diagnosed or treated. To reduce childhood death from cancer, it is important to understand the social-cultural context, values and beliefs that influence healthcare-seeking behaviours among the Tanzanian community. METHODS This was a cross-sectional qualitative study conducted in Mwanza, Kilimanjaro and Dar-es-Salaam regions between March and June 2021. We purposively selected community members aged ≥18 years from three rural and three urban settings to participate in seven focus group discussions (each with eight to 12 respondents). The participants were from communities without any affiliation to the treatment of children with cancer or treatment facilities. We transcribed, coded and analyzed data using a thematic-content approach with the support of NVIVO 12 software. RESULTS Many had heard of breast or cervical cancer; however, most were unaware of childhood cancer. Adults believe that cancer in children is caused by witchcraft and cannot be cured by modern medicines available at hospitals. These beliefs lead parents to first seek care from traditional healers, which hence delay presentation to the hospital. Other community concerns included the cost of transportation, investigation-related costs, and the long duration of treatment. These have an influence on treatment adherence leading to seeking alternative treatment, such as spiritual or traditional treatment. CONCLUSION Low community awareness, late hospital presentation, and treatment abandonment remain a challenge in childhood cancer in most parts of Tanzania. Belief about childhood cancer being a result of witchcraft and superstition contributes to limited health-seeking behaviours. Cultural and contextually relevant awareness campaign interventions are needed to increase cancer knowledge in Tanzanian communities.
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Affiliation(s)
- Erica Samson Sanga
- National Institute for Medical Research - Mwanza Centre, Mwanza, Tanzania
| | - Doris D Mbata
- National Institute for Medical Research - Muhimbili Centre, Muhimbili, Tanzania
| | - Elizabeth Francis Msoka
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Zaina Mchome
- National Institute for Medical Research - Mwanza Centre, Mwanza, Tanzania
| | - Francis P Karia
- Duke Office of Clinical Research (DOCR), School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University, School of Medicine, Durham, North Carolina, USA
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina, USA
| | - Joanna M Robles
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Cancer Prevention and Control Program, Atrium Health Wake Forest Baptist Comprehensive Cancer Centre, Winston Salem, North Carolina, USA
| | - Kristin Schroeder
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina, USA
- Pediatric Oncology and Global Health, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
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Sharma R, Abbastabar H, Abdulah DM, Abidi H, Abolhassani H, Abrehdari-Tafreshi Z, Absalan A, Ali HA, Abu-Gharbieh E, Acuna JM, Adib N, Sakilah Adnani QE, Aghaei A, Ahmad A, Ahmad S, Ahmadi A, Ahmadi S, Ahmed LA, Ajami M, Al Hamad H, Al Hasan SM, Alanezi FM, Saeed Al-Gheethi AA, Al-Hanawi MK, Ali A, Ali BA, Alimohamadi Y, Aljunid SM, Ali Al-Maweri SA, Alqahatni SA, AlQudah M, Al-Raddadi RM, Al-Tammemi AB, Ansari-Moghaddam A, Anwar SL, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Ariffin H, Artaman A, Arulappan J, Ashraf T, Askari E, Athar M, Wahbi Atout MM, Azadnajafabad S, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Bai R, Bajbouj K, Baliga S, Bardhan M, Bashiri A, Baskaran P, Basu S, Belgaumi UI, Nazer C Bermudez A, Bhandari B, Bhardwaj N, Bhat AN, Bitaraf S, Boloor A, Hashemi MB, Butt ZA, Chadwick J, Kai Chan JS, Chattu VK, Chaturvedi P, Cho WC, Darwesh AM, Dash NR, Dehghan A, Dhali A, Dianatinasab M, Dibas M, Dixit A, Dixit SG, Dorostkar F, Dsouza HL, Elbarazi I, Elemam NM, El-Huneidi W, Elkord E, Abdou Elmeligy OA, Emamian MH, Erkhembayar R, Ezzeddini R, Fadoo Z, Faiz R, Fakhradiyev IR, Fallahzadeh A, Faris MEM, Farrokhpour H, Fatehizadeh A, Fattahi H, Fekadu G, Fukumoto T, Gaidhane AM, Galehdar N, Garg P, Ghadirian F, Ghafourifard M, Ghasemi M, Nour MG, Ghassemi F, Gholamalizadeh M, Gholamian A, Ghotbi E, Golechha M, Goleij P, Goyal S, Mohialdeen Gubari MI, Gunasekera DS, Gunawardane DA, Gupta S, Habibzadeh P, Haeri Boroojeni HS, Halboub ES, Hamadeh RR, Hamoudi R, Harorani M, Hasanian M, Hassan TS, Hay SI, Heidari M, Heidari-Foroozan M, Hessami K, Hezam K, Hiraike Y, Holla R, Hoseini M, Hossain MM, Hossain S, Hsieh VCR, Huang J, Hussein NR, Hwang BF, Iravanpour F, Ismail NE, Iwagami M, Merin J L, Jadidi-Niaragh F, Jafarinia M, Jahani MA, Jahrami H, Jaiswal A, Jakovljevic M, Jalili M, Jamshidi E, Jayarajah U, Jayaram S, Jha SS, Jokar M, Joseph N, Kabir A, Kabir MA, Kadir DH, Kakodkar PV, Kalankesh LR, Kalankesh LR, Kalhor R, Kaliyadan F, Kamal VK, Kamal Z, Kamath A, Kar SS, Karimi H, Kaur N, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khan EA, Khan MN, Khan M, Khan MA, Khan YH, Khanmohammadi S, Khatatbeh MM, Khateri S, Khayamzadeh M, Khayat Kashani HR, Kim MS, Kompani F, Koohestani HR, Koulmane Laxminarayana SL, Krishan K, Kumar N, Kumar N, Kutluk T, Kuttikkattu A, Ching Lai DT, Lal DK, Lami FH, Lasrado S, Lee SW, Lee SW, Lee YY, Lee YH, Leong E, Li MC, Liu J, Madadizadeh F, Mafi AR, Mahjoub S, Malekzadeh R, Malik AA, Malik I, Mallhi TH, Mansournia MA, Martini S, Mathews E, Mathur MR, Meena JK, Menezes RG, Mirfakhraie R, Mirinezhad SK, Mirza-Aghazadeh-Attari M, Mithra P, Mohamadkhani A, Mohammadi S, Mohammadzadeh M, Mohan S, Mokdad AH, Al Montasir A, Montazeri F, Moradi M, Sarabi MM, Moradpour F, Moradzadeh M, Moraga P, Mosapour A, Motaghinejad M, Mubarik S, Muhammad JS, Murray CJ, Nagarajan AJ, Naghavi M, Nargus S, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen PT, Niazi RK, Noroozi N, Okati-Aliabad H, Okekunle AP, Ong S, Oommen AM, Padubidri JR, Pandey A, Park EK, Park S, Pati S, Patil S, Paudel R, Paudel U, Pirestani M, Podder I, Pourali G, Pourjafar M, Pourshams A, Syed ZQ, Radhakrishnan RA, Radhakrishnan V, Rahman M, Rahmani S, Rahmanian V, Ramesh PS, Rana J, Rao IR, Rao SJ, Rashedi S, Rashidi MM, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Roshandel G, Chandan S, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Saeed U, Safi SZ, Sharif-Askari FS, Sahebkar A, Sahoo H, Sajedi SA, Sajid MR, Salehi MA, Farrokhi AS, Sarasmita MA, Sargazi S, Sarode GS, Sarode SC, Sathian B, Satpathy M, Semwal P, Senthilkumaran S, Sepanlou SG, Shafeghat M, Shahabi S, Shahbandi A, Shahraki-Sanavi F, Shaikh MA, Shannawaz M, Sheikhi RA, Shobeiri P, Shorofi SA, Shrestha S, Siabani S, Singh G, Singh P, Singh S, Sinha DN, Siwal SS, Sreeram S, Suleman M, Abdulkader RS, Sultan I, Sultana A, Tabish M, Tabuchi T, Taheri M, Talaat IM, Tehrani-Banihashemi A, Temsah MH, Thangaraju P, Thomas N, Thomas NK, Tiyuri A, Tobe-Gai R, Toghroli R, Tovani-Palone MR, Ullah S, Unnikrishnan B, Upadhyay E, Tahbaz SV, Valizadeh R, Varthya SB, Waheed Y, Wang S, Wickramasinghe DP, Wickramasinghe ND, Xiao H, Yonemoto N, Younis MZ, Yu C, Zahir M, Zaki N, Zamanian M, Zhang ZJ, Zhao H, Zitoun OA, Zoladl M. Temporal patterns of cancer burden in Asia, 1990-2019: a systematic examination for the Global Burden of Disease 2019 study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100333. [PMID: 38361599 PMCID: PMC10866992 DOI: 10.1016/j.lansea.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year-wise estimates of incidence, mortality, and disability-adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age-specific incidence rates. Findings All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The age-standardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age-standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4-folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age-standardized DALYs rate was 2970.5/100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top-5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age-standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019. Interpretation With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early-stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control. Funding The GBD study is funded by the Bill and Melinda Gates Foundation.
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Wang X, Lian Z, Wu Q, Wu F, Zhang G, Liu J, Chen C, Sun J. Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis. Front Public Health 2024; 11:1305544. [PMID: 38303960 PMCID: PMC10832033 DOI: 10.3389/fpubh.2023.1305544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
Background There is a need to update the understanding of treatment refusal among cancer patients in China, taking into account recent developments. This study investigated how public insurance coverage of the first breast cancer targeted therapy contributed to the changes in treatment refusal among HER2-positive breast cancer patients in China. And it intensively examined and discussed additional barriers affecting patient utilization of innovative anticancer medicines based on the types and reasons for treatment refusal. Methods This retrospective study included female breast cancer patients diagnosed as HER2-positive who received treatment at a provincial oncology center in southern China between 2014 and 2020. Multivariable analysis was conducted using a binary logistic regression model. Subgroup analysis was performed with the same regression model. Results Among the 1,322 HER2-positive breast cancer patients who received treatment at the study hospital between 2014 and 2020, 327 (24.55%) had ever refused treatment. Economic reasons were reported as the primary cause by 142 patients (43.43%). Patients diagnosed after September 2017, when the first breast cancer targeted therapy was included in the public health insurance, were less likely to refuse treatment (OR = 0.64, 95% CI:0.45 ~ 0.91, p = 0.01) compared to those diagnosed before September 2017. Patients enrolled in the resident health insurance were more likely to refuse treatment (OR = 2.43, 95% CI:1.77 ~ 3.35, p < 0.001) than those enrolled in the employee health insurance. Conclusion This study reveals a high rate of treatment refusal among HER2-positive breast cancer patients, primarily attributed to financial factors. The disparity in public health insurance benefits resulted in a heavier economic burden for patients with less comprehensive benefits. Furthermore, the study identified challenges faced by patients seeking quality-assured cancer care in underdeveloped regions in China. By addressing economic barriers, promoting accurate health information, and improving cancer care capacity across the country can reduce the rate of treatment refusal.
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Affiliation(s)
- Xin Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Lian
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Qiyou Wu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Gong Zhang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jian Liu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Paéz V, Rodriguez-Fernandez M, Morales D, Torres C, Ardiles A, Soza S, Bustos C, Manríquez F, García C, Rocco R, Lang M. Quality of life, exercise capacity, cognition, and mental health of Chilean patients after COVID-19: an experience of a multidisciplinary rehabilitation program at a physical and rehabilitation medicine unit. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1274180. [PMID: 38107198 PMCID: PMC10722286 DOI: 10.3389/fresc.2023.1274180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
Background Post-COVID disabilities, encompassing physical, cognitive, and psychological aspects, constitute the primary health sequelae for survivors. While the rehabilitation needs post COVID-19 are now well understood, each country possesses unique characteristics in terms of populations, healthcare systems, social dynamics, and economic profiles, necessitating context-specific recommendations. This study aims to address two main objectives: (1) analyze the impact of an 8-week multidisciplinary rehabilitation program on the quality of life, functional capacity, cognition, and mental health adaptations in adults recovering from COVID-19 in northern Chile, and (2) propose a personalized model for predicting program dropouts and responses. Methods A total of 44 subjects were enrolled, forming two groups during the study: a treatment group (n = 32) and a dropout group (n = 12). The treatment group participated in the 8-week multidisciplinary rehabilitation program. Results The results indicate that (1) After 8 weeks, the quality of life of the patients in the treatment group exhibited significant improvements reflected in all aspects of the Short Form-36 Health Survey (SF36, p < 0.005) and the total score (p < 0.001), with a concurrent decrease in dysfunctionality (p < 0.001). (2) Significant improvements were also observed in various physical performance tests, including the: 6-minute walk test, 1-min sit-to-stand, dynamometry, Tinetti balance, and Berg score (p < 0.001). Moreover, physical therapy led to a reduction in neuropathic symptoms and pain, psychological therapy reduced anxiety and depression, and language therapy enhanced memory and speech (all p < 0.05). (3) Demographic and clinical history characteristics did not predict responses to rehabilitation. (4) A regression model for predicting changes in SF-36 total score, based on physical function, physical role, general health, and mental health, was established based on the data from study (p < 0.01, adjusted R2 = 0.893). (5) Classification models for predicting dropouts achieved 68% accuracy, with key predictors of treatment adherence including diabetes, hypertension, and dyslipidemia, Tinetti balance, physical role, and vitality of SF36, and performance on the 6-minute walk test and 1-minute sit-to-stand. Conclusions This study demonstrates significant enhancements in quality of life, improved functional performance, and reductions in mental and cognitive burdens within an 8-week rehabilitation program. Additionally, it is possible to identify patients at risk of dropping out using cost-effective, outpatient, and clinically applicable tests.
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Affiliation(s)
- Valeria Paéz
- Biomedical Department, Center for Research in Physiology and Medicine of Altitude, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Rodriguez-Fernandez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Morales
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Camillo Torres
- Department of Medical Sciences, University of Antofagasta, Antofagasta, Chile
| | - Andrés Ardiles
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Sergio Soza
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Cynthia Bustos
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Fernanda Manríquez
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Cesar García
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Rossana Rocco
- Physical Medicine and Rehabilitation Service, Clinical Hospital of the University of Antofagasta, Antofagasta, Chile
| | - Morin Lang
- Laboratorio de Fisiología del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
- Departamento de Ciencias de la Rehabilitación y Movimiento Humano, Facultad Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
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Ehrlich BS, McNeil MJ, Pham LTD, Chen Y, Rivera J, Acuna C, Sniderman L, Sakaan FM, Aceituno AM, Villegas CA, Force LM, Bolous NS, Wiphatphumiprates PP, Slone JS, Carrillo AK, Gillipelli SR, Duffy C, Arias AV, Devidas M, Rodriguez-Galindo C, Mukkada S, Agulnik A. Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Oncol 2023; 24:967-977. [PMID: 37517410 PMCID: PMC10812862 DOI: 10.1016/s1470-2045(23)00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. METHODS For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). FINDINGS Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). INTERPRETATION Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. FUNDING American Lebanese Syrian Associated Charities and National Cancer Institute.
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Affiliation(s)
- Bella S Ehrlich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Linh T D Pham
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jocelyn Rivera
- Department of Pediatric Emergency Medicine, Hospital Infantil Teletón de Oncología, Querétaro, México
| | - Carlos Acuna
- Department of Pediatric Intensive Care, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Liz Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Firas M Sakaan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Alejandra Mendez Aceituno
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Pediatric Intensive Care Unit, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Cesar A Villegas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jeremy S Slone
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela K Carrillo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Caitlyn Duffy
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Anita V Arias
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
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Langat S, Njuguna F, Olbara G, Martijn H, Sieben C, Haverkort M, Njenga D, Vik TA, Kaspers G, Mostert S. Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya. Support Care Cancer 2023; 31:467. [PMID: 37452971 PMCID: PMC10349750 DOI: 10.1007/s00520-023-07913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Few governments in low and middle-income countries (LMIC) have responded favourably to the international plea for Universal Health Coverage. Childhood cancer survival in LMIC is often below 20%. Limited health-insurance coverage may contribute to this poor survival. Our study explores the influence of health-insurance status on childhood cancer treatment outcomes in a Kenyan academic hospital. METHODS This was a retrospective medical records review of all children diagnosed with cancer at Moi Teaching and Referral Hospital between 2010 and 2016. Socio-demographic and clinical data was collected using a structured data collection form. Fisher's exact test, chi-squared test, Kaplan-Meier method, log-rank test and Cox proportional hazard model were used to evaluate relationships between treatment outcomes and patient characteristics. Study was approved by Institutional Research Ethics Committee. FINDINGS From 2010-2016, 879 children were newly diagnosed with cancer. Among 763 patients whose records were available, 28% abandoned treatment, 23% died and 17% had progressive/relapsed disease resulting in 32% event-free survival. In total 280 patients (37%) had health-insurance at diagnosis. After active enrolment during treatment, total health-insurance registration level reached 579 patients (76%). Treatment outcomes differed by health-insurance status (P < 0.001). The most likely treatment outcome in uninsured patients was death (49%), whereas in those with health-insurance at diagnosis and those who enrolled during treatment it was event-free survival (36% and 41% respectively). Overall survival (P < 0.001) and event-free survival (P < 0.001) were higher for insured versus uninsured patients. The hazard-ratio for treatment failure was 0.30 (95% CI:0.22-0.39; P < 0.001) for patients insured at diagnosis and 0.32 (95% CI:0.24-0.41; P < 0.001) for patients insured during treatment in relation to those without insurance. INTERPRETATION Our study highlights the need for Universal Health Coverage in LMIC. Children without health-insurance had significantly lower survival. Childhood cancer treatment outcomes can be ameliorated by strategies that improve health-insurance access.
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Affiliation(s)
- Sandra Langat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Hugo Martijn
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Cenne Sieben
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Moniek Haverkort
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dennis Njenga
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
- Department of Pediatrics, Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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7
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Yilmaz B, Koc A, Dogru O, Tufan Tas B, Senay RE. The results of the modified St Jude Total Therapy XV Protocol in the treatment of low- and middle-income children with acute lymphoblastic leukemia. Leuk Lymphoma 2023; 64:1304-1314. [PMID: 37165575 DOI: 10.1080/10428194.2023.2205976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023]
Abstract
The St Jude Total Therapy Study XV was the first clinical trial to prospectively use minimal residual disease levels during and after remission induction therapy to guide risk-directed treatment. We used the Total Therapy XV protocol with minimal modification in treating 115 newly diagnosed pediatric acute lymphoblastic leukemia patients from low- and middle-income groups from January 2011 to December 2017. The mean age at diagnosis was 5.97 ± 3.96 years. The median follow-up period was 88 months. Three (2.6%) patients had bone marrow relapse, and one (0.87%) had an isolated central nervous system relapse. Nineteen of the patients (16.52%) died due to infection-related complications, three (2.61%) died due to progressive disease, and one (0.87%) died due to hematopoietic stem cell transplant complications. Five-year overall survival was 80%, and event-free survival was 78.3%. Our results showed that the Total XV treatment protocol could be used successfully in patients with ALL from low- and middle-income populations. However, infection-related deaths remain a significant problem.
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Affiliation(s)
- Baris Yilmaz
- Pediatric Hematology and Oncology, SB Marmara University Medical School Education and Research Hospital, Istanbul, Türkiye
| | - Ahmet Koc
- Pediatric Hematology and Oncology, SB Marmara University Medical School Education and Research Hospital, Istanbul, Türkiye
| | - Omer Dogru
- Pediatric Hematology and Oncology, SB Marmara University Medical School Education and Research Hospital, Istanbul, Türkiye
| | - Burcu Tufan Tas
- Pediatric Hematology and Oncology, SB Marmara University Medical School Education and Research Hospital, Istanbul, Türkiye
| | - Rabia Emel Senay
- Pediatric Hematology and Oncology, SB Marmara University Medical School Education and Research Hospital, Istanbul, Türkiye
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8
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Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania. PLoS One 2022; 17:e0273296. [PMCID: PMC9674137 DOI: 10.1371/journal.pone.0273296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Worldwide, an estimated 400,000 children develop cancer each year. The bulk of the mortalities from these cases occur in low-and-middle-income countries (LMICs). In Sub-Saharan Africa, there is a tremendous need to strengthen the capacity of health systems to provide high-quality cancer care for children. However, a lack of data on the economic impact of cancer treatment in low-resource settings hinders its consideration as a healthcare priority. To address this gap, this study models the clinical and financial impact of pediatric cancer care in Tanzania, a lower-middle income country in East Africa. Methods We conducted a retrospective review of patients with cancer under the age of 19 years treated at Bugando Medical Centre from January 2010 to August 2014. Information was collected from a total of 161 children, including demographics, type of cancer, care received, and five-year survival outcomes. This data was used to calculate the number of averted disability-adjusted life-years (DALYs) with treatment. Charges for all direct medical costs, fixed provider costs, and variable provider costs were used to calculate total cost of care. The societal economic impact of cancer treatment was modeled using the value of statistical life (VSL) and human capital methods. Findings The total health impact for these 161 children was 819 averted DALYs at a total cost of $846,743. The median cost per patient was $5,064 ($4,746–5,501 interquartile range). The societal economic impact of cancer treatment ranged from $590,534 to $3,647,158 using VSL method and $1,776,296 using a human capital approach. Interpretation Despite the limitations of existing treatment capacity, economic modeling demonstrates a positive economic impact from providing pediatric cancer care in Tanzania. As many countries like Tanzania progress towards achieving Universal Health Coverage, these key economic indicators may encourage future investment in comprehensive pediatric cancer care programs in low-resource settings to achieve clinically and economically beneficial results not only for the individual patients, but for the country as a whole.
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9
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Palayullakandi A, Trehan A, Jain R, Kumar R, Mittal BR, Kapoor R, Srinivasan R, Kakkar N, Bansal D. Retrospective single-center experience with OEPA/COPDAC and PET-CT based strategy for pediatric Hodgkin lymphoma in a LMIC setting. Pediatr Hematol Oncol 2022; 39:587-599. [PMID: 35271413 DOI: 10.1080/08880018.2022.2044418] [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] [Indexed: 10/18/2022]
Abstract
ABVD regimen for Hodgkin lymphoma (HL) is frequently used in children and young adults in low-middle income countries (LMIC). The feasibility and safety data for 'non-ABVD' protocols from LMIC is limited. The retrospective study was conducted in a single center in India. The Euronet PHL-C1 based protocol was administered during 2010-19. A PET-CT was performed at diagnosis and following two OEPA cycles. Radiotherapy was administered for inadequate PET response. During the 10-year period, 143 patients with HL were treated. The mean age was 7.8 ± 2.5 years. Bulky disease was observed in 82 (59%). Treatment abandonment was recorded in 13 (9.1%). The median follow-up duration was 46.4 months. An inadequate PET response was observed in 41/119 (34.4%), of which 56.1% received radiotherapy. Twelve (29.3%) patients who were supposed to receive radiotherapy received 2-cycles of COPDAC instead. Sixty-nine episodes of febrile neutropenia were observed in 54 patients. Treatment-related mortality (TRM) was observed in 7 (5.3%). The majority of episodes of febrile neutropenia (61%) and TRM (86%) occurred in the first cycle of OEPA. The 4-year event-free survival (EFS) and overall survival (OS) were 86.2 ± 3.4% and 93.5 ± 2.2%, respectively. Nine (6.3%) patients relapsed. Bulky disease lacked association with inadequate PET response (p = .800) or relapse (p = 1.000). OEPA/COPDAC regimen and response assessment by PET-CT permitted therapy reduction, including radiotherapy. Febrile neutropenia and resultant TRM (5.3%) are concerning and occurred frequently in the first cycle of OEPA. The support system for managing febrile neutropenia should be optimized for administering OEPA in LMIC.
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Affiliation(s)
- Achanya Palayullakandi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Mirutse MK, Tolla MT, Memirie ST, Palm MT, Hailu D, Abdi KA, Buli ED, Norheim OF. The magnitude and perceived reasons for childhood cancer treatment abandonment in Ethiopia: from health care providers' perspective. BMC Health Serv Res 2022; 22:1014. [PMID: 35941600 PMCID: PMC9361525 DOI: 10.1186/s12913-022-08188-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Treatment abandonment is one of major reasons for childhood cancer treatment failure and low survival rate in low- and middle-income countries. Ethiopia plans to reduce abandonment rate by 60% (2019–2023), but baseline data and information about the contextual risk factors that influence treatment abandonment are scarce. Methods This cross-sectional study was conducted from September 5 to 22, 2021, on the three major pediatric oncology centers in Ethiopia. Data on the incidence and reasons for treatment abandonment were obtained from healthcare professionals. We were unable to obtain data about the patients’ or guardians’ perspective because the information available in the cancer registry was incomplete to contact adequate number of respondents. We used a validated, semi-structured questionnaire developed by the International Society of Pediatric Oncology Abandonment Technical Working Group. We included all (N = 38) health care professionals (physicians, nurses, and social workers) working at these centers who had more than one year of experience in childhood cancer service provision (a universal sampling and 100% response rate). Results The perceived mean abandonment rate in Ethiopia is 34% (SE 2.5%). The risk of treatment abandonment is dependent on the type of cancer (high for bone sarcoma and brain tumor), the phase of treatment and treatment outcome. The highest risk is during maintenance and treatment failure or relapse for acute lymphoblastic leukemia, and during pre- or post-surgical phase for Wilms tumor and bone sarcoma. The major influencing risk factors in Ethiopia includes high cost of care, low economic status, long travel time to treatment centers, long waiting time, belief in the incurability of cancer and poor public awareness about childhood cancer. Conclusions The perceived abandonment rate in Ethiopia is high, and the risk of abandonment varies according to the type of cancer, phase of treatment or treatment outcome. Therefore, mitigation strategies to reduce the abandonment rate should include identifying specific risk factors and prioritizing strategies based on their level of influence, effectiveness, feasibility, and affordability. Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08188-8.
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Affiliation(s)
| | - Mieraf Taddesse Tolla
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Ole F Norheim
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
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11
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Srinivasan S, Gollamudi VRM, Dhariwal N. Pediatric Acute Myeloid Leukemia in India: A Systematic Review. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1754370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background Lower-middle-income countries face unique problems in the management of pediatric acute myeloid leukemia (AML) due to which the outcomes have not kept pace with developed nations. In India, data on childhood AML is sparsely available, thus making a true assessment of disease trends difficult. The current systematic review was undertaken to assess the outcomes of childhood AML from published literature from India over a period of 10 years (2011–2021).
Materials and Methods A systematic search of MEDLINE, Google Scholar, and SCOPUS was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement from January 1, 2011 to December 31, 2021. In addition, International Society of Pediatric Oncology (SIOP) conference abstracts were also screened for relevant studies on AML from India. This study was registered in PROSPERO (ID42021273218).
Results A total of 1,210 patients from 19 studies were included. Standard 3 + 7 and MRC AML based regimens were commonly adopted regimens for induction. Remission rates varied between 56 and 95%. Overall treatment-related mortality across studies was 23.2% (95% confidence interval [CI]: 10.3–35.9%). The mean incidence of treatment abandonment was 19.3% ( 95% CI: 10.9–27.5%). Event-free survival and overall survival were in the range of 28 to 55% and 15 to 66%, respectively. Hematopoietic stem cell transplantation was performed only on a small subset of patients.
Conclusion Outcomes of pediatric AML in India continue to be suboptimal with high treatment abandonment and toxic deaths. Ensuring uniform access to therapy and supportive care along with a robust social support system would improve outcomes of childhood AML in India.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkata Rama Mohan Gollamudi
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nidhi Dhariwal
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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12
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Rahiman EA, Bakhshi S, Deepam Pushpam, Ramamoorthy J, Das A, Ghara N, Kalra M, Kapoor G, Meena JP, Siddaigarhi S, Thulkar S, Sharma MC, Srinivasan R, Trehan A. Outcome and prognostic factors in childhood B non-Hodgkin lymphoma from India: Report by the Indian Pediatric Oncology Group (InPOG-NHL-16-01 study). Pediatr Hematol Oncol 2022; 39:391-405. [PMID: 34978257 DOI: 10.1080/08880018.2021.2002485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The literature on B-non-Hodgkin lymphoma (NHL) in India is restricted to individual hospital data. The study aimed to evaluate the epidemiology and outcome of B-NHL in our country. One hundred and ninety-one patients of B-NHL from 10 centers diagnosed between 2013 and 2016 were analyzed retrospectively. B/T lymphoblastic lymphoma and patients with inadequate data were excluded. The median age was 88 months (IQR: 56, 144) with an M:F ratio of 5.6:1. Undernourishment and stunting were seen in 36.5% and 22%. Primary site was abdomen in 66.5%. Hypoalbuminemia was noted in 82/170 (48.2%). Histological subtypes: Burkitt lymphoma (BL): 69.6%, Burkitt-like: 10.4%, and diffuse large B cell lymphoma (DLBCL): 13.6%, unclassified and others (6.4%). Stage distribution: I/II, 33 (17.3%), III, 114 (59.7%), and IV, 44 (23%). One-eighty-six patients took treatment. Protocols used were LMB and BFM in 160/186 (86%). At a median follow-up of 21.34 (IQR: 4.34, 36.57) months, the disease-free-survival (DFS) was 74.4% and event-free-survival (EFS) was 60.7%. Treatment-related mortality (TRM), relapse/progression and abandonment were 14.3%, 14.5%, and 8.4%, respectively. Bone marrow positivity, stage IV disease, and lactate dehydrogenase (LDH) > 2,000 U/l predicted inferior EFS. Stage IV disease, LDH > 2,000 U/l, bone marrow positivity, tumor lysis syndrome and low albumin predicted TRM; LDH retained significance on multivariate analysis for EFS and TRM [OR: 4.54, 95% CI: 1.14-20, p 0.03; OR 20, 95%CI: 1.69-250, p 0.017]. BL was the main histological subtype. High TRM and relapse/progression are hampering survival. An LDH > 2,000 U/l was adversely prognostic. These data demonstrate a need to develop a national protocol that balances toxicity and potential for cure.
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Affiliation(s)
- Emine A Rahiman
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Bakhshi
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjay Thulkar
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Meher Chand Sharma
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Srinivasan
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Afungchwi GM, Kruger M, Hesseling P, van Elsland S, Ladas EJ, Marjerrison S. Survey of the use of traditional and complementary medicine among children with cancer at three hospitals in Cameroon. Pediatr Blood Cancer 2022; 69:e29675. [PMID: 35441798 DOI: 10.1002/pbc.29675] [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: 09/30/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is lack of diagnostic and treatment resources with variable access to childhood cancer treatment in low- and middle-income countries (LMIC), which may lead to subsequent poor survival. The primary aim of this study was to determine the prevalence and types of traditional and complementary medicine (T&CM) used in Cameroon. Secondarily, we explored determinants of T&CM use, associated costs, perceived benefits and harm, and disclosure of T&CM use to medical team. METHODS A prospective, cross-sectional survey among parents and carers of children younger than 15 years of age who had a cancer diagnosis and received cancer treatment at three Baptist Mission hospitals between November 2017 and February 2019. RESULTS Eighty participants completed the survey. Median patient age was 8.1 years (IQR4.1-11.1). There was significant availability (90%) and use (67.5%) of T&CM, whereas 24% thought T&CM would be good for cancer treatment. Common T&CM remedies included herbs and other plant remedies or teas taken by mouth, prayer for healing purposes and skin cutting. Living more than five hours away from the treatment center (P = 0.030), anticipated costs (0.028), and a habit of consulting a traditional healer when sick (P = 0.006) were associated with the use of T&CM. T&CM was mostly paid for in cash (53.7%) or provided free of charge (29.6%). Of importance was the fact that nearly half (44%) did not want to disclose the use of TM to their doctor. CONCLUSION Pediatric oncology patients used T&CM before and during treatment but were unlikely to disclose its use to the child's health care team.
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Affiliation(s)
- Glenn M Afungchwi
- Childhood Cancer Program, 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
| | - Peter Hesseling
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine van Elsland
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York
| | - Stacey Marjerrison
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Faculty of Health Sciences, Departments of Pediatric and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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14
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Haier J, Schaefers J. Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups. Cancers (Basel) 2022; 14:cancers14133158. [PMID: 35804928 PMCID: PMC9265013 DOI: 10.3390/cancers14133158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care. Abstract Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.
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15
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Sharma R, Jani C. Mapping incidence and mortality of leukemia and its subtypes in 21 world regions in last three decades and projections to 2030. Ann Hematol 2022; 101:1523-1534. [PMID: 35536353 DOI: 10.1007/s00277-022-04843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
This study examines the burden of leukemia and its subtypes at the global, regional, and national levels in 21 world regions and 204 countries in the last three decades. The estimates of incidence, deaths, and age-standardized rates of leukemia for 21 regions and 204 countries for 1990-2019 were extracted from the Global Burden of Disease 2019 study. Average annual percentage change in 1990-2019 for 21 regions was utilized for projecting leukemia burden in 2030. Globally, there were 643,579 [586,980-699,729] incident cases and 334,592 [306,818-360,214] deaths in 2019 due to leukemia, up from 474,924 [388,559-560,550] cases and 263,263 [233,664-298,696] deaths in 1990. Between 1990 and 2019, the age-standardized incidence rate (ASIR) decreased from 9.6 [8.1-11.0] in 1990 to 8.2 [7.5-8.9] per 100,000 person-years in 2019, and the age-standardized mortality rate (ASMR) decreased from 5.8/100,000 [5.2-6.4] in 1990 to 4.3/100,000 [3.9-4.6] in 2019. Between 1990 and 2019, the ASIR decreased in majority of regions except Western Europe and high-income Asia Pacific, whereas the ASMR decreased in all 21 regions. In 2019, country-wise, the ASIR varied from 3.0/100,000 [2.3-3.7] in Palau to 35.1/100,000 [26.4-47.2] in San Marino and the ASMR spanned from 2.3/100,000 [1.7-2.8] in San Marino to 15.8/100,000 [12.0-20.4] in Syria. As per our projections, globally, there will be 720,168 incident cases and 367,804 deaths due to leukemia in 2030. Substantial improvements have been witnessed in leukemia mortality rates in all regions, especially high-income regions and countries. Health care policies focusing on diagnostic improvements, cancer registration, and newer therapeutics at reduced cost or with insurance coverage are needed in low and middle-income countries.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entreprenuership, Delhi Technological University, East Delhi Campus, Room No. 305, Vivek Vihar Phase II, Delhi, 110095, India.
| | - Chinmay Jani
- Mount Aubrun Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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16
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Schroeder K, Maiarana J, Gisiri M, Joo E, Muiruri C, Zullig L, Masalu N, Vasudevan L. Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study. JMIR Pediatr Parent 2021; 4:e27988. [PMID: 34889763 PMCID: PMC8701707 DOI: 10.2196/27988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. OBJECTIVE The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. METHODS In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. RESULTS All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. CONCLUSIONS To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone-based education and communication strategy suggests that a mobile phone-based intervention, particularly one that utilizes SMS technology, could be feasible in this setting.
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Affiliation(s)
- Kristin Schroeder
- Department of Pediatric Oncology, Duke University Medical Center, Durham, NC, United States.,Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania.,Duke Global Health Institute, Durham, NC, United States
| | - James Maiarana
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mwitasrobert Gisiri
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Emma Joo
- Duke Global Health Institute, Durham, NC, United States
| | - Charles Muiruri
- Duke Global Health Institute, Durham, NC, United States.,Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Leah Zullig
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Durham Veterans Affairs Center of Innovation to Accelerate and Practice Transformation, Durham, NC, United States
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, United States.,Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
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17
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Circulating miR-146a expression as a non-invasive predictive biomarker for acute lymphoblastic leukemia. Sci Rep 2021; 11:22783. [PMID: 34815474 PMCID: PMC8611079 DOI: 10.1038/s41598-021-02257-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023] Open
Abstract
Dysregulation of non-coding microRNAs during the course of tumor development, invasion and/or progression to the distant organs, makes them a promising candidate marker for the diagnosis of cancer and associated malignancies. This exploratory study aims at evaluating the usefulness of plasma concentration of circulating mir-146a as a non-invasive biomarker for acute lymphoblastic leukemia (ALL). Total RNA including miRNA was isolated from 110 plasma samples of patients (n = 66), healthy controls (n = 24) and follow up (n = 20) cases and reverse transcribed. Relative concentrations were assessed using real-time quantitative PCR and fold-change was calculated by 2−ΔΔCt method. Finally, relative concentrations were correlated to clinicopathological factors. Patients (n = 66) were analyzed to determine fold expression of miR-146a in plasma samples of ALL. Before chemotherapy, pediatric (n = 42) and adult (n = 24) showed overexpression of miR-146a compared with healthy controls (P < 0.0001). There was no effect of age and gender on mir-146a expression in plasma. mirR-146a expression was independent of clinical and hematological features. Moreover, miR-146a levels in plasma of paired samples (n = 20) after treatment showed significant decrease in expression (P < 0.001). Expression of plasma miR-146a may be utilized as non-invasive marker to diagnose and predict prognosis in pediatric and adult patients with ALL. Moreover predicted targets may be utilized for ALL therapy in future.
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18
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van Weelderen RE, Njuguna F, Klein K, Mostert S, Langat S, Vik TA, Olbara G, Kipng'etich M, Kaspers GJL. Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya. Cancer Rep (Hoboken) 2021; 5:e1576. [PMID: 34811958 PMCID: PMC9575503 DOI: 10.1002/cnr2.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.
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Affiliation(s)
- Romy E van Weelderen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kim Klein
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sandra Langat
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Terry A Vik
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gilbert Olbara
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Martha Kipng'etich
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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19
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Indraswari BW, Kelling E, Vassileva SM, Sitaresmi MN, Danardono D, Mulatsih S, Supriyadi E, Widjajanto PH, Sutaryo S, Kaspers GL, Mostert S. Impact of universal health coverage on childhood cancer outcomes in Indonesia. Pediatr Blood Cancer 2021; 68:e29186. [PMID: 34114307 DOI: 10.1002/pbc.29186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low- and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital. METHODS Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained. FINDINGS After introduction of UHC, the number of insured patients increased from 38% to 82% (P < 0.001). Among low SES population, insurance coverage increased from 40% to 85% (P < 0.001), and among high SES population from 33% to 77% (P < 0.001). In the overall population, treatment abandonment decreased from 36% to 22% (P < 0.001). Event-free survival estimates at four years after diagnosis of overall population improved from 16% to 22% (P < 0.001). Hazard ratio for treatment failure was 1.26 (CI: 1.07-1.48, P = 0.006) for uninsured versus insured patients. In the low SES population, treatment abandonment decreased from 36% to 19% (P < 0.001). Event-free survival estimates at four years after diagnosis of low SES population improved from 14% to 22% (P < 0.001). INTERPRETATION Introduction of UHC in Indonesia contributed significantly to better treatment outcome and event-free survival of children with cancer from low SES families.
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Affiliation(s)
- Braghmandita Widya Indraswari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Emil Kelling
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sofi M Vassileva
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Danardono Danardono
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sutaryo Sutaryo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan L Kaspers
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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20
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Medical Cost of Cancer Care for Privately Insured Children in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136746. [PMID: 34201571 PMCID: PMC8267683 DOI: 10.3390/ijerph18136746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.
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21
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Van Weelderen RE, Klein K, Natawidjaja MD, De Vries R, Kaspers GJ. Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature. Expert Rev Anticancer Ther 2021; 21:765-780. [PMID: 33779466 DOI: 10.1080/14737140.2021.1895756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Survival rates of pediatric acute myeloid leukemia (AML) in low- and middle-income countries (LMICs) seem extremely poor, and the available literature on the matter is scarce. Accordingly, there is a limited understanding of poor treatment outcomes seen in this population.Areas covered: We provide an overview of the available literature with respect to treatment outcomes of pediatric AML in LMICs yielding poor outcomes compared to high-income countries. Moreover, treatment outcomes vary markedly between LMICs. In addition, there is a wide variation among studies in how treatment outcomes are reported and analyzed.Expert opinion: The substantially inferior treatment outcomes of pediatric AML in LMICs emphasize the unprecedented importance of global initiatives and international collaborations to improve the survival of these patients. A coordinated approach is necessary to carry out country-specific situational analyses. These analyses will result in operational plans on how to structurally implement childhood cancer registries, align healthcare infrastructure, build on capacities, and provide universal health coverage in LMICs. In addition, we strongly recommend that, in the future, LMICs document, analyze, and publish pediatric AML treatment outcomes in a more structured and uniform manner.
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Affiliation(s)
- Romy E Van Weelderen
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Kim Klein
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Meyrina D Natawidjaja
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralph De Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gertjan Jl Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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22
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Sharma R. A Systematic Examination of Burden of Childhood Cancers in 183 Countries: Estimates from GLOBOCAN 2018. Eur J Cancer Care (Engl) 2021; 30:e13438. [PMID: 33723880 DOI: 10.1111/ecc.13438] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Childhood cancers are a significant cause of child deaths worldwide. This study examines the burden of 33 childhood cancers in 183 countries. METHODS The estimates of age-, sex- and country-wise incidence and deaths due to 33 childhood cancers (below the age 15) for 183 countries were retrieved from GLOBOCAN 2018. The socioeconomic status of a country was measured by human development index (HDI). RESULTS Globally, an estimated 200 166 cases and 74 956 deaths were attributed to childhood cancers in 2018. The age-standardised incidence rate (ASIR) was 103 per million, whereas the age-standardised mortality rate (ASMR) stood at 38 per million. ASIR was highest in high-income regions (e.g. North America: 182 per million); ASMR, however, was elevated in low- and medium-income countries (e.g. south-east Asia: 62 per million; North Africa: 51 per million). Leukaemia and brain cancers were dominant cancer groups accounting for 45% of cases and 57% of deaths. The ASIRs exhibited a positive gradient with HDI ( R 2 = 0.46 ) . CONCLUSION The high burden of childhood cancers (>80% of total incidence) in low- and middle-income countries (LMICs) calls for increased cancer awareness, improvement in oncologic infrastructure, international collaborations and twinning programmes, equitable access to multi-modal treatment and financial coverage of treatment expenses.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India
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23
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Maillie L, Masalu N, Mafwimbo J, Maxmilian M, Schroeder K. Delays Experienced by Patients With Pediatric Cancer During the Health Facility Referral Process: A Study in Northern Tanzania. JCO Glob Oncol 2020; 6:1757-1765. [PMID: 33201744 PMCID: PMC7713565 DOI: 10.1200/go.20.00407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa present at an advanced stage. Delays can occur at any time during the care-seeking process from symptom onset to treatment initiation. Referral delay, the time from first presentation at a health facility to oncologist evaluation, is a key component of total delay that has not been evaluated in sub-Saharan Africa. METHODS Over a 3-month period, caregivers of children diagnosed with cancer at a regional cancer center (Bugando Medical Centre [BMC]) in Tanzania were consecutively surveyed to determine the number and type of health facilities visited before presentation, interventions received, and transportation used to reach each facility. RESULTS Forty-nine caregivers were consented and included in the review. A total of 124 facilities were visited before BMC, with 31% of visits (n = 38) resulting in a referral. The median referral delay was 89 days (mean, 122 days), with a median of two facilities (mean, 2.5 facilities) visited before presentation to BMC. Visiting a traditional healer first significantly increased the time taken to reach BMC compared with starting at a health center/dispensary (103 v 236 days; P = .02). Facility visits in which a patient received a referral to a higher-level facility led to significantly decreased time to reach BMC (P < .0001). Only 36% of visits to district hospitals and 20.6% of visits to health centers/dispensaries yielded a referral, however. CONCLUSION The majority of patients were delayed during the referral process, but receipt of a referral to a higher-level facility significantly shortened delay time. Referral delay for pediatric patients with cancer could be decreased by raising awareness of cancer and strengthening the referral process from lower-level to higher-level facilities.
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Affiliation(s)
- Luke Maillie
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Judy Mafwimbo
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania.,Division of Pediatric Hematology/Oncology and Duke Global Cancer Program, Duke University Medical Center, Durham, NC
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24
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Ford K, Gunawardana S, Manirambona E, Philipoh GS, Mukama B, Kanyamuhunga A, Cartledge P, Nyoni MJ, Mwaipaya D, Mpwaga J, Bokhary Z, Scanlan T, Heinsohn T, Hathaway H, Mansfield R, Wilson S, Lakhoo K. Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study. World J Surg 2020; 44:295-302. [PMID: 31605179 DOI: 10.1007/s00268-019-05213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT). METHODS This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death). RESULTS There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X2 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X2 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks. CONCLUSIONS This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.
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Affiliation(s)
- K Ford
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | | | - E Manirambona
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - G S Philipoh
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - B Mukama
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - A Kanyamuhunga
- Department of Pediatric Oncology, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - P Cartledge
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.,Yale University, New Haven, USA
| | - M J Nyoni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - D Mwaipaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J Mpwaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Z Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - T Scanlan
- Department of Pediatric Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | - S Wilson
- Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK
| | - K Lakhoo
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. .,Oxford University, Oxford, UK. .,Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania. .,Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK.
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25
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Githang'a J, Brown B, Chitsike I, Schroeder K, Chekwenda-Makore N, Majahasi F, Ogundoyin O, Renner L, Petricca K, Denburg AE, Horton SE, Gupta S. The cost-effectiveness of treating childhood cancer in 4 centers across sub-Saharan Africa. Cancer 2020; 127:787-793. [PMID: 33108002 DOI: 10.1002/cncr.33280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost-effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub-Saharan Africa. METHODS Within hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost-effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy. RESULTS Cost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical personnel in the other 3 centers. The cost per disability-adjusted life-year averted ranged from 0.3 to 3.6 times the per capita gross national income. Childhood cancer treatment therefore was considered to be very cost-effective by World Health Organization standards in 2 countries and cost-effective in 1 additional country. In all centers, abandonment of treatment was common; modeling exercises suggested that public funding of treatment, additional psychosocial personnel, and modifications of inpatient policies would increase survival rates while maintaining or even improving cost-effectiveness. CONCLUSIONS Across various African countries, childhood cancer treatment units represent cost-effective interventions. Cost-effectiveness can be increased through the control of drug prices, appropriate policy environments, and decreasing the rate of treatment abandonment. These results will inform national childhood cancer strategies across Africa.
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Affiliation(s)
- Jessie Githang'a
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
| | - Biobele Brown
- Department of Paediatrics, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Inam Chitsike
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kristin Schroeder
- Department of Pediatrics and Global Health, Duke University School of Medicine, Durham, North Carolina
| | - Nester Chekwenda-Makore
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Olakayode Ogundoyin
- Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Lorna Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Kadia Petricca
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram E Denburg
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sue E Horton
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sumit Gupta
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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26
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Palagyi A, Balane C, Shanthosh J, Jun M, Bhoo-Pathy N, Gadsden T, Canfell K, Jan S. Treatment abandonment in children with cancer: Does a sex difference exist? A systematic review and meta-analysis of evidence from low- and middle-income countries. Int J Cancer 2020; 148:895-904. [PMID: 32875569 DOI: 10.1002/ijc.33279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022]
Abstract
In this systematic review and meta-analyses, we sought to determine sex-disparities in treatment abandonment in children with cancer in low- and middle-income countries (LMICs) and identify the characteristics of children and their families most disadvantaged by such abandonment. Sex-disaggregated data on treatment abandonment were collated from the available literature and a random-effects meta-analysis was conducted to compare the rates in girls with those in boys. Subgroup analyses were conducted in which studies were stratified by design, cancer type and the Gender Inequality Index of the country of study. Eighteen studies were included in the systematic review and of these studies, 16 qualified for the meta-analysis, representing 10 754 children. The pooled rate of treatment abandonment overall was 30%. We observed no difference in the proportion of treatment abandonment in girls relative to estimates observed in boys (rate ratio [RR] 0.95, 95% CI: 0.79-1.15; P = .61). There was significant heterogeneity across the included studies and in the pooled estimate of RR for girls vs boys (both I2 > 98%). Subgroup analyses did not reveal any effect on abandonment risk. Risk factors for abandonment observed fell into three main categories: socio-demographic; geographic; and travel-related. In conclusion, a high rate of treatment abandonment (30%) was observed overall for children with cancer in included studies in LMICs, although this was variable and context specific. No evidence of gender bias in childhood cancer treatment abandonment rates across LMICs was found. Given that the risk factors for abandonment are context specific, in-depth country-level analyses may provide further insights into the role of a child's gender in treatment abandonment decisions.
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Affiliation(s)
- Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Christine Balane
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Janani Shanthosh
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Australian Human Rights Institute, Faculty of Law, University of New South Wales, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Price of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, Lam CG, Ward ZJ, Yeh JM, Allemani C, Coleman MP, Di Carlo V, Loucaides E, Fitchett E, Girardi F, Horton SE, Bray F, Steliarova-Foucher E, Sullivan R, Aitken JF, Banavali S, Binagwaho A, Alcasabas P, Antillon F, Arora RS, Barr RD, Bouffet E, Challinor J, Fuentes-Alabi S, Gross T, Hagander L, Hoffman RI, Herrera C, Kutluk T, Marcus KJ, Moreira C, Pritchard-Jones K, Ramirez O, Renner L, Robison LL, Shalkow J, Sung L, Yeoh A, Rodriguez-Galindo C. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21:e185-e224. [PMID: 32240612 DOI: 10.1016/s1470-2045(20)30022-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
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Affiliation(s)
- Rifat Atun
- Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Avram Denburg
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Lindsay Frazier
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine G Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elizabeth Fitchett
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Fabio Girardi
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, King's College London, London, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Shripad Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Center, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Patricia Alcasabas
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and the School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas Gross
- Center for Global Health, US National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lars Hagander
- Department of Clinical Sciences Lund, Pediatric Surgery, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cristian Herrera
- Health Division, Organization for Economic Cooperation and Development, Paris, France; Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatrics, Division of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Karen J Marcus
- Department of Radiation Oncology, Harvard Medical School, Harvard University, Boston MA, USA; Division of Radiation Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Claude Moreira
- Institut Jean Lemerle, African Paediatric Oncology Formation, Dakar, Senegal; Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Kathy Pritchard-Jones
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Ramirez
- Department of Pediatric Haematology and Oncology, Centro Médico Imbanaco de Cali, Cali, Colombia; Cali Cancer Population-based Registry, Universidad del Valle, Cali, Colombia
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School Accra, Ghana; Paediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jaime Shalkow
- Department of Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico City, Mexico; School of Medicine, Anahuac University, Mexico City, Mexico
| | - Lillian Sung
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Yeoh
- Division of Paediatric Haematology and Oncology, National University Cancer Institute, Singapore National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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Affiliation(s)
- Susan Horton
- University of Waterloo, Waterloo, Ontario, Canada
| | - Sumit Gupta
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Koffi KG, Silué DA, Laurent C, Boidy K, Koui S, Compaci G, Adeba ZH, Kamara I, Botty RP, Bognini AS, Sanogo I, Despas F, Laurent G. AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study. BMC Cancer 2019; 19:1247. [PMID: 31870438 PMCID: PMC6929302 DOI: 10.1186/s12885-019-6478-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.
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Affiliation(s)
- K G Koffi
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire.
| | - D A Silué
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - C Laurent
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - K Boidy
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - S Koui
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - G Compaci
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - Z H Adeba
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - I Kamara
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - R P Botty
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - A S Bognini
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - I Sanogo
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - F Despas
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - G Laurent
- Hematology Department of Toulouse University Medical Center, Toulouse, France
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Fung A, Horton S, Zabih V, Denburg A, Gupta S. Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review. BMJ Glob Health 2019; 4:e001825. [PMID: 31749998 PMCID: PMC6830048 DOI: 10.1136/bmjgh-2019-001825] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/20/2019] [Accepted: 10/12/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION A major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic review to synthesise existing evidence on the costs and cost-effectiveness of treating childhood cancers in LMICs. METHODS We searched multiple databases from their inception to March 2019. All studies reporting costs or cost-effectiveness of treating any childhood cancer in an LMIC were included. We appraised included articles using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Where possible, we extracted or calculated the cost per disability-adjusted life year (DALY) averted using reported survival and country-specific life expectancy. Cost/DALY averted was compared with per capita gross domestic product (GDP) as per WHO-Choosing Interventions that are Cost-Effective guidelines to determine cost-effectiveness. RESULTS Of 2802 studies identified, 30 met inclusion criteria. Studies represented 22 countries and nine different malignancies. The most commonly studied cancers were acute lymphoblastic leukaemia (n=10), Burkitt lymphoma (n=4) and Wilms tumour (n=3). The median CHEERS checklist score was 18 of 24. Many studies omitted key cost inputs. Notably, only 11 studies included healthcare worker salaries. Cost/DALY averted was extracted or calculated for 12 studies and ranged from US$22 to US$4475, although the lower-end costs were primarily from studies that omitted key cost components. In all 12, cost/DALY averted through treatment was substantially less than country per capita GDP, and therefore considered very cost-effective. CONCLUSION Many included studies did not account for key cost inputs, thus underestimating true treatment costs. Costs/DALY averted were nonetheless substantially lower than per capita GDP, suggesting that even if all relevant inputs are included, LMIC childhood cancer treatment is consistently very cost-effective. While additional rigorous economic evaluations are required, our results can inform the development of LMIC national childhood cancer strategies.
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Affiliation(s)
- Alastair Fung
- Pediatrics and Child Health, Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Veda Zabih
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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Memirie ST, Habtemariam MK, Asefa M, Deressa BT, Abayneh G, Tsegaye B, Abraha MW, Ababi G, Jemal A, Rebbeck TR, Verguet S. Estimates of Cancer Incidence in Ethiopia in 2015 Using Population-Based Registry Data. J Glob Oncol 2019; 4:1-11. [PMID: 30241262 PMCID: PMC6223441 DOI: 10.1200/jgo.17.00175] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Noncommunicable diseases, prominently cancer, have become the second leading cause of death in the adult population of Ethiopia. A population-based cancer registry has been used in Addis Ababa (the capital city) since 2011. Availability of up-to-date estimates on cancer incidence is important in guiding the national cancer control program in Ethiopia. Methods We obtained primary data on 8,539 patients from the Addis Ababa population-based cancer registry and supplemented by data on 1,648 cancer cases collected from six Ethiopian regions. We estimated the number of the commonest forms of cancer diagnosed among males and females in Ethiopia and computed crude and age-standardized incidence rates. Results For 2015 in Ethiopia, we estimated that 21,563 (95% CI, 17,416 to 25,660) and 42,722 (95% CI, 37,412 to 48,040) incident cancer cases were diagnosed in males and females, respectively. The most common adult cancers were: cancers of the breast and cervix, colorectal cancer, non-Hodgkin lymphoma, leukemia, and cancers of the prostate, thyroid, lung, stomach, and liver. Leukemia was the leading cancer diagnosis in the pediatric age group (age 0 to 14 years). Breast cancer was by far the commonest cancer, constituting 33% of the cancers in women and 23% of all cancers identified from the Addis Ababa cancer registry. It was also the commonest cancer in four of the six Ethiopian regions included in the analysis. Colorectal cancer and non-Hodgkin lymphoma were the commonest malignancies in men. Conclusion Cancer, and more prominently breast cancer, poses a substantial public health threat in Ethiopia. The fight against cancer calls for expansion of population-based registry sites to improve quantifying the cancer burden in Ethiopia and requires both increased investment and application of existing cancer control knowledge across all segments of the Ethiopian population.
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Affiliation(s)
- Solomon Tessema Memirie
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mahlet Kifle Habtemariam
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Asefa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniyam Tefera Deressa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Getamesay Abayneh
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniam Tsegaye
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mihiret Woldetinsae Abraha
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Girma Ababi
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Timothy R Rebbeck
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Stéphane Verguet
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
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Sinha S, Brattström G, Palat G, Rapelli V, Segerlantz M, Brun E, Wiebe T. Treatment Adherence and Abandonment in Acute Myeloid Leukemia in Pediatric Patients at a Low-Resource Cancer Center in India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aim: One of the causes for lower cure rates in acute childhood leukemia in low- and middle- income countries (LMIC) compared to high-income countries is abandonment from treatment. The International Society of Pediatric Oncology (SIOP) defines abandonment as failure to begin treatment or an absence of 4 weeks during treatment. The aim of this study was to evaluate the extent of abandonment among patients diagnosed with acute myeloid leukemia (AML) at the pediatric ward at a low-resource cancer center in India. Methods: Medical records of all patients, aged 0–15 years, diagnosed with AML between January 1, 2014, and March 31, 2015, at the hospital were reviewed. Age, sex, date of diagnosis, and survival during the short follow-up time after completed treatment and information regarding abandonment were collected. SIOP definition of abandonment was used. Eight patients were diagnosed with AML at the hospital whereof 65 met the inclusion criteria of this study. Results: Of the included 65 patients, 6 died before treatment could be initiated and 3 were referred to palliative care upfront. Thus, 56 patients were offered curatively intended treatment. Of these patients, six refused treatment at this stage and another five abandoned during therapy. Altogether, 11 children abandoned treatment. Conclusion: In this study, the abandonment rate from treatment of childhood AML was 20%, which is in concordance from other studies conducted in India and other LMIC, stating that abandonment is a problem and hindrance when treating with a curative intent.
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Affiliation(s)
- Sudha Sinha
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | | | - Gayatri Palat
- Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
- Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Vineela Rapelli
- Palliative Care Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane
| | - Eva Brun
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University
- Department of Radiotherapy and Radiophysics, Skane University Hospital
| | - Thomas Wiebe
- Department of Clinical Sciences, Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
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Ferman S, Lima FFDS, Lage CRS, da Hora SS, Vianna DT, Thuler LC. Preventing treatment abandonment for children with solid tumors: A single-center experience in Brazil. Pediatr Blood Cancer 2019; 66:e27724. [PMID: 30938082 DOI: 10.1002/pbc.27724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/19/2019] [Accepted: 02/23/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of treatment abandonment have been considered one of the major limitations to achieving high cure rates of childhood cancer in developing countries. The aims of this study were to report the prevalence and factors associated with treatment abandonment for children diagnosed with solid tumors in one reference center in Brazil and to describe effective strategies to prevent it. PROCEDURES A retrospective review was conducted using data from 1139 children (0-18 years) treated for solid tumors at the Brazilian National Cancer Institute, during the period between January 2012 and December 2017. Treatment abandonment was defined as recommended by the International Society of Pediatric Oncology. The impact of implementing a patient-tracking system was evaluated. Descriptive statistics were used to analyze patient characteristics. Chi-square test was used for statistical analysis, with the significance level <0.05. RESULTS Of 1139 patients, 1.66% refused or abandoned treatment. Although from 2012 to 2013 there was an increase in the abandonment rate, it then decreased by 63.8% from 2013 to 2017 (2.5% to 0.9%). In the multivariate model, only retinoblastoma diagnosis was associated with abandonment (odds ratio = 5.0; 95% confidence interval, 1.2-20.4; P = 0.025). In our cohort, abandonment rates were not associated with increased death. CONCLUSION Monitoring missed appointments, and early interventions to address issues associated with providing resources to help families during treatment were effective in achieving very low abandonment rates.
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Affiliation(s)
- Sima Ferman
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | | | - Senir Santos da Hora
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | - Luiz Claudio Thuler
- Clinical Research Division, Brazilian National Cancer Institute, INCA, Brazil
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Jatia S, Prasad M, Paradkar A, Bhatia A, Narula G, Chinnaswamy G, Vora T, Gomle S, Sankaran H, Banavali S. Holistic support coupled with prospective tracking reduces abandonment in childhood cancers: A report from India. Pediatr Blood Cancer 2019; 66:e27716. [PMID: 30900819 DOI: 10.1002/pbc.27716] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND High cure rates of over 80% in childhood cancers reported from high-income countries (HICs) are not replicated in low- and middle-income countries (LMICs). Treatment abandonment (TxA) is an important reason for this poorer outcome. We assessed the effect of a holistic support group approach coupled with prospective tracking on TxA in children with cancer in a limited-resources environment. METHODS In 2010, all existing nongovernmental organizations (NGOs) working with childhood cancer at our hospital were brought together to form a pediatric cancer foundation with the aim of providing holistic support to the patient and family, including financial, psychosocial, lodging, educational, and bereavement support. Simultaneously, prospective tracking of all children with a Time-Responsive Electronic Abandonment Tracking (TREAT) system was also established. The impact of these measures on TxA over the 2009-2016 period was compared using the log-rank test. RESULTS The annual rate of abandonment reduced from 20% in 2009 to 10.4% in 2010 and 5.2% in 2011. It has been consistently between 3% and 6% from 2012 to 2016 (P -0.04). TxA after the initiation of treatment dropped from 9% in 2009 to 1% in 2016 (P -0.02), while refusal to initiate treatment dropped from 11% to 2.7% (P -0.23) over the same period. CONCLUSIONS A holistic support group consisting of the hospital team, as well as existing NGOs and governmental organizations, along with a systematic and prospective tracking system significantly reduced abandonment in a resource-constrained setting. This cost-effective holistic support group may be applicable in other LMICs with similar healthcare systems.
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Affiliation(s)
- Shalini Jatia
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Amey Paradkar
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Ameeta Bhatia
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Tushar Vora
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sanjay Gomle
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Hari Sankaran
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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Denburg AE, Laher N, Mutyaba I, McGoldrick S, Kambugu J, Sessle E, Orem J, Casper C. The cost effectiveness of treating Burkitt lymphoma in Uganda. Cancer 2019; 125:1918-1928. [PMID: 30840316 DOI: 10.1002/cncr.32006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Perceptions of high cost and resource intensity remain political barriers to the prioritization of childhood cancer treatment programs in many low- and middle-income countries (LMICs). Little knowledge exists of the actual cost and cost-effectiveness of such programs. To improve outcomes for children with Burkitt lymphoma (BL), the most common childhood cancer in Africa, the Uganda Cancer Institute implemented a comprehensive BL treatment program in 2012. We undertook an economic evaluation of the program to ascertain the cost-effectiveness of BL therapy in a specific LIC setting. METHODS We compared the treatment of BL to usual care in a cohort of 122 patients treated between 2012 and 2014. Costs included variable, fixed, and family costs. Our primary measure of effectiveness was overall survival (OS). Patient outcomes were determined through prospective capture and retrospective chart abstraction. The cost per disability-adjusted life-year (DALY) averted was calculated using the World Health Organization's Choosing Interventions That Are Cost-Effective (WHO-CHOICE) methodology. RESULTS The 2-year OS with treatment was 55% (95% CI, 45% to 64%). The cost per DALY averted in the treatment group was US$97 (Int$301). Cumulative estimate of national DALYs averted through treatment was 8607 years, and the total national annual cost of treatment was US$834,879 (Int$2,590,845). The cost of BL treatment fell well within WHO-CHOICE cost-effectiveness thresholds. The ratio of cost per DALY averted to per capita gross domestic product was 0.14, reflecting a very cost-effective intervention. CONCLUSION This study demonstrates that treating BL with locally tailored protocols is very cost-effective by international standards. Studies of this kind will furnish crucial evidence to help policymakers prioritize the allocation of LMIC health system resources among noncommunicable diseases, including childhood cancer.
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Affiliation(s)
- Avram E Denburg
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nazeefah Laher
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Wellesley Institute, Toronto, Ontario, Canada
| | - Innocent Mutyaba
- Uganda Cancer Institute, Makerere University, Kampala, Uganda
- Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, Seattle, Washington
| | - Suzanne McGoldrick
- Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, Seattle, Washington
| | - Joyce Kambugu
- Uganda Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Jackson Orem
- Uganda Cancer Institute, Makerere University, Kampala, Uganda
- Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, Seattle, Washington
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, Seattle, Washington
- Infectious Disease Research Institute, University of Washington School of Medicine, Seattle, Washington
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Cohen P, Friedrich P, Lam C, Jeha S, Metzger ML, Qaddoumi I, Naidu P, Faughnan L, Rodriguez-Galindo C, Bhakta N. Global Access to Essential Medicines for Childhood Cancer: A Cross-Sectional Survey. J Glob Oncol 2019; 4:1-11. [PMID: 30582430 PMCID: PMC7010437 DOI: 10.1200/jgo.18.00150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Global data mapping access to essential chemotherapeutics for pediatric cancer are scarce. We report a survey of international pediatric cancer care providers’ access to these medicines. Methods A Web-based survey was sent to pediatric oncologists registered on the Cure4Kids Web portal. We queried chemotherapeutics in the WHO Essential Medicines List for Children, from which the average proportional availability was summarized as each country’s access score. In addition, we examined availability of drug packages defined by the WHO-sanctioned Expert Committee for eight pediatric cancers. We undertook a sensitivity analysis investigating how regimen access would change if the cytotoxics specified in recent agreements between the Clinton Health Access Initiative, American Cancer Society, and pharmaceutical companies were universally available. Results There were significant (P < .001) differences in the median access scores between World Bank income groups, and 42.9% of respondents from low-income and lower middle–income countries reported suboptimal access scores. Our disease-based analysis revealed that 42.1% of patients in low-income and lower middle–income countries lacked full access to chemotherapy packages. Guaranteed availability of the cytotoxics specified in the Clinton Health Access Initiative/American Cancer Society agreements was projected to increase this regimen-based access by 1.6%, although including four additional chemotherapeutics would further increase coverage by 13.9%. Conclusion This study is the first, to our knowledge, to assess worldwide variation in practical access to pediatric chemotherapy. Although mapping the proportion of available chemotherapeutics is informative, we also developed a meaningful estimate of access using disease-specific drug packages. These data provide an important baseline for continued monitoring and can aid in planning adaptive treatment guidelines that consider the trade-offs between access and outcomes.
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Affiliation(s)
- Phillip Cohen
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Paola Friedrich
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Catherine Lam
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Monika L Metzger
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Ibraham Qaddoumi
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Paula Naidu
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Lane Faughnan
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Carlos Rodriguez-Galindo
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
| | - Nickhill Bhakta
- Phillip Cohen, Children's Hospital of Philadelphia, Philadelphia, PA; Phillip Cohen, Centre for Global Health, Trinity College Dublin, Dublin, Ireland; and Paola Friedrich, Catherine Lam, Sima Jeha, Monika L. Metzger, Ibraham Qaddoumi, Paula Naidu, Lane Faughnan, Carlos Rodriguez-Galindo, and Nickhill Bhakta, St Jude Children's Research Hospital, Memphis, TN
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Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science 2019; 363:1182-1186. [DOI: 10.1126/science.aaw4892] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through multidisciplinary care and research, with treatment regimens using mostly generic medicines and optimized risk stratification. Children’s outcomes in LMICs can be improved through global collaborative partnerships that help local leaders adapt effective treatments to local resources and clinical needs, as well as address common problems such as delayed diagnosis and treatment abandonment. Together, these approaches may bring within reach the global survival target recently set by the World Health Organization: 60% survival for all children with cancer by 2030.
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Chantada G, Lam CG, Howard SC. Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment. Br J Haematol 2019; 185:1125-1135. [DOI: 10.1111/bjh.15785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Catherine G. Lam
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis TNUSA
| | - Scott C. Howard
- University of Tennessee Health Science Center Memphis TN USA
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Alam A, Kumar A. Impact of financial support and focussed group counselling on treatment abandonment in children with acute lymphoblastic leukaemia. Experience over 22 years from North India. Psychooncology 2018; 28:372-378. [DOI: 10.1002/pon.4951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Areesha Alam
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
| | - Archana Kumar
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
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Gibson TN, Beeput S, Gaspard J, George C, Gibson D, Jackson N, Leandre-Broome V, Palmer-Mitchell N, Alexis C, Bird-Compton J, Bodkyn C, Boyle R, McLean-Salmon S, Reece-Mills M, Quee-Brown CS, Allen U, Weitzman S, Blanchette V, Gupta S. Baseline characteristics and outcomes of children with cancer in the English-speaking Caribbean: A multinational retrospective cohort. Pediatr Blood Cancer 2018; 65:e27298. [PMID: 30094928 DOI: 10.1002/pbc.27298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND English-speaking Caribbean (ESC) childhood cancer outcomes are unknown. PROCEDURE Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection. RESULTS A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage. CONCLUSIONS ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements.
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Affiliation(s)
- T N Gibson
- The University Hospital of the West Indies, Kingston, Jamaica
| | - S Beeput
- Bustamante Hospital for Children, Kingston, Jamaica
| | - J Gaspard
- Victoria Hospital, Castries, St. Lucia
| | - C George
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - D Gibson
- Princess Margaret Hospital, Nassau, Bahamas
| | - N Jackson
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | | | - C Alexis
- Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - C Bodkyn
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - R Boyle
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | - M Reece-Mills
- The University Hospital of the West Indies, Kingston, Jamaica
| | | | - U Allen
- The Hospital for Sick Children, Toronto, Canada
| | - S Weitzman
- The Hospital for Sick Children, Toronto, Canada
| | | | - S Gupta
- The Hospital for Sick Children, Toronto, Canada
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Mardakis S, Arora RS, Bakhshi S, Arora A, Anis H, Tsimicalis A. A qualitative study of the costs experienced by caregivers of children being treated for cancer in New Delhi, India. Cancer Rep (Hoboken) 2018. [DOI: 10.1002/cnr2.1149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Stephanie Mardakis
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Canada
- Montreal Children's HospitalMcGill University Health Centre Montreal Canada
| | - Ramandeep S. Arora
- Max Institute of CancerMax Healthcare New Delhi India
- Quality Care, Research and ImpactCanKids…KidsCan New Delhi India
| | - Sameer Bakhshi
- Medical OncologyAll India Institute of Medical Sciences New Delhi India
| | - Ashima Arora
- Medical OncologyAll India Institute of Medical Sciences New Delhi India
| | - Huma Anis
- Quality Care, Research and ImpactCanKids…KidsCan New Delhi India
| | - Argerie Tsimicalis
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Canada
- Clinical ResearchShriners Hospitals for Children—Canada Montreal Canada
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Rodriguez-Romo L, Olaya Vargas A, Gupta S, Shalkow-Klincovstein J, Vega-Vega L, Reyes-Lopez A, Cicero-Oneto C, Mejia-Arangure J, Gonzalez-Ramella O, Pineiro-Retif R, Lopez-Facundo A, de los Angeles Del Campo-Martinez M, Tejocote I, Brennan K, Booth CM. Delivery of Pediatric Cancer Care in Mexico: A National Survey. J Glob Oncol 2018; 4:1-12. [PMID: 30084750 PMCID: PMC6223522 DOI: 10.1200/jgo.17.00238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Limited data describe the delivery of pediatric cancer care in Mexico. We report a nationwide survey of pediatric cancer units. Methods An electronic survey was distributed to 74 pediatric cancer units in Mexico to describe case volumes; organization of care; and availability of medical/surgical specialists, supportive care, complex therapies, and diagnostic services. Centers were classified as low (< 30 new patients/year), medium (30 to 59/year) and high (≥ 60/year). Results Sixty-two centers completed the survey (response rate, 84%). The median annual new case volume per center was 50 (interquartile range [IQR], 23 to 81). Thirty-four percent (n = 21), 26% (n = 16), and 40% (n = 25) of units were low-, medium-, and high-volume centers, respectively. Treatment units reported a median of two pediatric oncologists (IQR, 2) and one pediatric hematologist (IQR, 1 to 2). Availability of medical and surgical subspecialists varied by center size, with substantially more specialist support at higher-volume centers ( P < .01). Multidisciplinary tumor boards are available at 29% (six of 21), 56% (nine of 16), and 76% (19 of 25) of low- to high-volume centers, respectively ( P = .005). Radiation and palliative care services are available at 42% (n = 26) and 63% (n = 36) of all centers, which did not vary by center volume. Educational support for hospitalized children and school reintegration programs are available at 56% (n = 36) and 58% (n = 36) of centers, respectively. One third (38% [n = 23]) of centers reported that at least one half of patients were lost to follow-up during the transition from pediatric to adult programs. Conclusion A large variation exists in annual case volumes across Mexican pediatric cancer centers. Additional efforts to increase access to multidisciplinary, supportive, and palliative care across all pediatric cancer units in Mexico are required.
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Affiliation(s)
- Laura Rodriguez-Romo
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Alberto Olaya Vargas
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Sumit Gupta
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Jaime Shalkow-Klincovstein
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Lourdes Vega-Vega
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Alfonso Reyes-Lopez
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Carlo Cicero-Oneto
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Juan Mejia-Arangure
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Oscar Gonzalez-Ramella
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Rafael Pineiro-Retif
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Aracely Lopez-Facundo
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Maria de los Angeles Del Campo-Martinez
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Isidoro Tejocote
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Kelly Brennan
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
| | - Christopher M. Booth
- Laura Rodriguez-Romo, Queen’s University; Kelly Brennan and Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico
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Vasquez L, Diaz R, Chavez S, Tarrillo F, Maza I, Hernandez E, Oscanoa M, García J, Geronimo J, Rossell N. Factors associated with abandonment of therapy by children diagnosed with solid tumors in Peru. Pediatr Blood Cancer 2018; 65:e27007. [PMID: 29431252 DOI: 10.1002/pbc.27007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. METHODS We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. RESULTS Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. CONCLUSION Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results.
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Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Rosdali Diaz
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sharon Chavez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Fanny Tarrillo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Eddy Hernandez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Monica Oscanoa
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Juan García
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jenny Geronimo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Nuria Rossell
- Amsterdam Institute for Social Sciences Research, University of Amsterdam, Amsterdam, The Netherlands
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Rossell N, Salaverria C, Hernandez A, Alabi S, Vasquez R, Bonilla M, Lam CG, Ribeiro R, Reis R. Community resources support adherence to treatment for childhood cancer in El Salvador. J Psychosoc Oncol 2018; 36:319-332. [PMID: 29452054 DOI: 10.1080/07347332.2018.1427174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In order to reduce nonadherence and treatment abandonment of children with cancer in El Salvador, institutions located nearby the patients' homes were involved to provide support. Methodological approach: Health clinics and municipality offices in the patients' communities were asked to assist families who were not promptly located after missing hospital appointments, or those whose financial limitations were likely to impede continuation of treatment. Data was collected about the number of contacted institutions, the nature of help provided, staff's time investments, and parents' perceptions about the intervention. FINDINGS Local institutions (133 from 206 contacts) conducted home visits (83), and/or provided parents with money (55) or transportation (60). Parents found this support essential for continuing the treatment but they also encountered challenges regarding local institutions' inconsistencies. Nonadherence and abandonment decreased. IMPLICATIONS Economic burden was reduced on both the families and the hospital. Involvement of external institutions might become regular practice to support families of children with cancer.
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Affiliation(s)
- Nuria Rossell
- a Amsterdam Institute for Social Science Research (AISSR), Amsterdam University , Amsterdam , The Netherlands.,b Department of Oncology , Benjamin Bloom Hospital , San Salvador , El Salvador
| | - Carmen Salaverria
- b Department of Oncology , Benjamin Bloom Hospital , San Salvador , El Salvador
| | - Angelica Hernandez
- b Department of Oncology , Benjamin Bloom Hospital , San Salvador , El Salvador
| | - Soad Alabi
- b Department of Oncology , Benjamin Bloom Hospital , San Salvador , El Salvador
| | - Roberto Vasquez
- b Department of Oncology , Benjamin Bloom Hospital , San Salvador , El Salvador
| | - Miguel Bonilla
- c International Outreach Program, St. Jude Children's Research Hospital , Memphis , Tennessee , USA
| | - Catherine G Lam
- c International Outreach Program, St. Jude Children's Research Hospital , Memphis , Tennessee , USA.,d Department of Oncology , St. Jude Children's Research Hospital , Memphis , Tennessee , USA.,e College of Medicine, University of Tennessee , Memphis , Tennessee , USA
| | - Raul Ribeiro
- d Department of Oncology , St. Jude Children's Research Hospital , Memphis , Tennessee , USA.,e College of Medicine, University of Tennessee , Memphis , Tennessee , USA
| | - Ria Reis
- a Amsterdam Institute for Social Science Research (AISSR), Amsterdam University , Amsterdam , The Netherlands.,f Leiden University Medical Center , Leiden , The Netherlands.,g School of Child and Adolescent Health, University of Cape Town, The Children's Institute , Cape Town , South Africa
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Mansell R, Purssell E. Treatment abandonment in children with cancer in Sub-Saharan Africa: Systematic literature review and meta-analysis. J Adv Nurs 2017; 74:800-808. [DOI: 10.1111/jan.13476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 01/01/2023]
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Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F, Castellanos M, Sweet-Cordero EA, Messacar K, Kurap J, Bustamante M, Howard SC, Efron B, Luna-Fineman S. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatr Blood Cancer 2017; 64. [PMID: 28423236 DOI: 10.1002/pbc.26560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.
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Affiliation(s)
- Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Midori Seppa
- Stanford University School of Medicine, Palo Alto, California
| | - Silvia Rivas
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - E Alejandro Sweet-Cordero
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kevin Messacar
- Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | - John Kurap
- Hilo Bay Clinic, Community Health Center, Hilo, Hawaii
| | | | - Scott C Howard
- School of Health Studies, University of Memphis, Tennessee
| | - Bradley Efron
- Department of Statistics and Biostatistics, Stanford University, Palo Alto, California
| | - Sandra Luna-Fineman
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
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Fuentes-Alabi S, Bhakta N, Vasquez RF, Gupta S, Horton SE. The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network. Cancer 2017; 124:391-397. [PMID: 28915337 DOI: 10.1002/cncr.31022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness. METHODS Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates. RESULTS The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective. CONCLUSIONS Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society.
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Affiliation(s)
- Soad Fuentes-Alabi
- Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Sumit Gupta
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan E Horton
- Global Health Economics, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Bonaventure A, Harewood R, Stiller CA, Gatta G, Clavel J, Stefan DC, Carreira H, Spika D, Marcos-Gragera R, Peris-Bonet R, Piñeros M, Sant M, Kuehni CE, Murphy MFG, Coleman MP, Allemani C. Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries. Lancet Haematol 2017; 4:e202-e217. [PMID: 28411119 PMCID: PMC5418564 DOI: 10.1016/s2352-3026(17)30052-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. METHODS Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (<1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). FINDINGS We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1-18·2) in the Chinese registries to 86·8% (81·6-92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI 42·8-61·9) in Cali, Colombia, to 91·6% (89·5-93·6) in the German registries, and for AML ranged from 33·3% (18·9-47·7) in Bulgaria to 78·2% (72·0-84·3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. INTERPRETATION Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood cancer survival. FUNDING Canadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK, US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, and the University of Kentucky.
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Affiliation(s)
- Audrey Bonaventure
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Rhea Harewood
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Oxford, UK
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jacqueline Clavel
- National Registry of Childhood Haematopoietic Malignancies, INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des Cancers de l'Enfant et de l'Adolescent, Paris, France
| | | | - Helena Carreira
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Devon Spika
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Catalan Institute of Oncology-Girona, Girona, Spain
| | | | - Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael F G Murphy
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Diorio C, Lam CG, Ladas EJ, Njuguna F, Afungchwi GM, Taromina K, Marjerrison S. Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review. J Glob Oncol 2016; 3:791-800. [PMID: 29244989 PMCID: PMC5735959 DOI: 10.1200/jgo.2016.005587] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Traditional and complementary medicine (T&CM) strategies are commonly used in pediatric oncology. Patterns may vary based on country income. We systematically reviewed published studies describing T&CM use among pediatric oncology patients in low-income countries (LIC/LMIC), middle-income countries (UMIC), and high-income countries (HIC). Objectives included describing estimated prevalence of use, reasons for use, perceived effectiveness, modalities used, rates of disclosure, and reporting of delayed or abandoned treatment. Methods MEDLINE, EMBASE, Global Health, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Cochrane Database of Systematic Reviews, and ProceedingsFirst were searched. Inclusion criteria were primary studies involving children younger than the age of 18 years, undergoing active treatment of cancer, and any T&CM use. Exclusion criteria included no pediatric oncology–specific outcomes and studies involving only children off active treatment. Data were extracted by two reviewers using a systematic data extraction form determined a priori. Results Sixty-five studies published between 1977 and 2015 were included, representing 61 unique data sets and 7,219 children from 34 countries. The prevalence of T&CM use ranged from 6% to 100%. Median rates of use were significantly different in LIC/LMIC (66.7% ± 19%), UMIC (60% ± 26%), and HIC (47.2% ± 20%; P = .02). Rates of disclosure differed significantly by country income, with higher median rates in HIC. Seven studies reported on treatment abandonment or delays. Conclusion The use of T&CM in pediatric oncology is common worldwide, with higher median prevalence of use reported in LIC/LMIC. Further research is warranted to examine the impact on treatment abandonment and delay.
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Affiliation(s)
- Caroline Diorio
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Catherine G Lam
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Elena J Ladas
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Festus Njuguna
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Glenn M Afungchwi
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Katherine Taromina
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
| | - Stacey Marjerrison
- Caroline Diorio and Stacey Marjerrison, McMaster Children's Hospital, Hamilton, Ontario, Canada; Catherine G. Lam, St. Jude Children's Research Hospital, Memphis, TN; Elena J. Ladas and Katherine Taromina, Columbia University Medical Center, New York City, NY; Festus Njuguna, Moi University, Eldoret, Kenya; and Glenn M. Afungchwi, Banso Baptist Hospital, Kumbo, Cameroon
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Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey. PLoS One 2016; 11:e0163090. [PMID: 27736871 PMCID: PMC5063311 DOI: 10.1371/journal.pone.0163090] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject. METHODS Physicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately. RESULTS 581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families' low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others. CONCLUSION TxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.
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