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Ganguly S, Bakhshi S. Unique Challenges in the Management of Retinoblastoma in India - Need for Country-Specific Guidelines. Indian J Pediatr 2024:10.1007/s12098-024-05184-0. [PMID: 38831252 DOI: 10.1007/s12098-024-05184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Shuvadeep Ganguly
- Department of Medical Oncology, Regional Cancer Centre, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Ganguly S, Bakhshi S. Treating Pediatric Acute Promyelocytic Leukemia in India - Key Challenges and Lessons Learned. Indian J Pediatr 2024; 91:535-536. [PMID: 38159153 DOI: 10.1007/s12098-023-05014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Shuvadeep Ganguly
- Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Das G, Setlur K, Jana M, Ramakrishnan L, Jain V, Meena JP, Gupta AK, Dwivedi SN, Seth R. Serum Adipokines as Biomarkers for Surveillance of Metabolic Syndrome in Childhood Acute Lymphoblastic Leukemia Survivors in Low Middle-Income Countries. Nutr Cancer 2024; 76:262-270. [PMID: 38225859 DOI: 10.1080/01635581.2023.2301139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Serum adipokines (leptin and adiponectin) are dysregulated before the onset of metabolic syndrome and hence may be useful biomarkers for screening of cardiometabolic late effects in childhood Acute Lymphoblastic Leukemia (cALL) survivors. METHODS We compared serum adipokine levels between 40 cALL survivors (aged 10-18 years, >2 years from treatment completion) with similar controls. A multivariable logistic regression analysis was then done to assess the association of metabolic syndrome in cALL survivors with variables including adipokines and other metabolic parameters, demographic and treatment details, and Dual-energy X-ray absorptiometry scan-derived variables. RESULTS Compared to controls, cALL survivors had a higher prevalence of metabolic syndrome (8/40 vs. 2/40, P = .044) and central obesity (11/40 vs. 4/40, P = 0.042). Median Serum Leptin (7.39 vs. 4.23 ng/ml, P = 0.207) levels and derived Leptin-Adiponectin Ratio (1.44 vs. 0.80, P = 0.598), were higher but not statistically different in our survivors compared to controls; Adiponectin levels were similar (6.07 vs. 5.01 µg/ml, P = 0.283). In the cALL survivors, overweight/obesity (odds ratio [OR] 21.9, P = 0.020) or higher Leptin levels (OR 1.11, P = 0.047), were independently associated with metabolic syndrome. CONCLUSIONS Serum Leptin, independently predictive of metabolic syndrome in our cALL survivors, may be tested in larger studies to assess its utility in surveillance and initiation of early preventive measures.
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Affiliation(s)
- Gargi Das
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Kritika Setlur
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences-New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences-New Delhi, India
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences-New Delhi, India
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
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Krishnan S, Mahadevan A, Mungle T, Gogoi MP, Saha V. Maintenance Treatment in Acute Lymphoblastic Leukemia: A Clinical Primer. Indian J Pediatr 2024; 91:47-58. [PMID: 37493925 DOI: 10.1007/s12098-023-04687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
Cure rates in pediatric acute lymphoblastic leukemia (ALL) currently approach 90% in the developed world. Treatment involves 6-8 mo of intensive multi-drug chemotherapy followed by 24 mo of maintenance treatment (ALL-MT). The cornerstone of ALL-MT is the daily administration of oral 6-mercaptopurine (6MP), a purine analogue. 6MP is combined with weekly oral methotrexate (MTX), an antifolate drug, to augment therapeutic activity. Some protocols include additional chemotherapy drugs (such as vincristine and corticosteroids) during MT. The objective of ALL-MT is to ensure uninterrupted treatment at the highest tolerated doses of 6MP and MTX. This requires periodic adjustments of 6MP and MTX doses throughout treatment. Tolerance is determined through regular clinical assessments and careful monitoring of blood counts. Tolerated drug doses vary widely among patients, influenced by genetic and non-genetic factors, and require individualized dosing. Suboptimal treatment intensity in ALL-MT is associated with inferior outcomes and results from failure to treat at highest tolerated drug doses and/or interruptions in treatment due to non-adherence or toxicity. Management of MT thus requires close supervision to ensure treatment adherence, periodic drug dose modifications, and treatment to tolerance, while minimizing treatment interruptions due to toxicity. The review highlights these challenges and discusses approaches and strategies for the management of MT, focusing on the Indian context.
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Affiliation(s)
- Shekhar Krishnan
- Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, 14 Major Arterial Road (East-West), Newtown, Rajarhat, Kolkata, West Bengal, 700160, India.
- Department of Pediatric Hematology and Oncology, Tata Medical Center, Kolkata, India.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK.
| | - Ananya Mahadevan
- Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, 14 Major Arterial Road (East-West), Newtown, Rajarhat, Kolkata, West Bengal, 700160, India
| | - Tushar Mungle
- Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, 14 Major Arterial Road (East-West), Newtown, Rajarhat, Kolkata, West Bengal, 700160, India
| | - Manash Pratim Gogoi
- Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, 14 Major Arterial Road (East-West), Newtown, Rajarhat, Kolkata, West Bengal, 700160, India
| | - Vaskar Saha
- Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, 14 Major Arterial Road (East-West), Newtown, Rajarhat, Kolkata, West Bengal, 700160, India
- Department of Pediatric Hematology and Oncology, Tata Medical Center, Kolkata, India
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
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5
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Li CK, Kurkure P, Arora RS, Chen BW, Kirgizov K, Okamoto Y, Seksarn P, Tang Y, Yoo KH, Agarwal B, Chan GC, Dalvi R, Hori H, Khan MS, Yu A, Nakagawara A. Current Challenges of Asian National Children's Cancer Study Groups on Behalf of Asian Pediatric Hematology and Oncology Group. JCO Glob Oncol 2023; 9:e2300153. [PMID: 37656946 PMCID: PMC10581612 DOI: 10.1200/go.23.00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
In Asia, a few countries have a long and established history of collaborative clinical trials successfully formed national children's cancer study groups, but many still do not have such groups. The process of forming national children's cancer groups is fraught with many hurdles, which varies among the countries. One of the basic requirements for running clinical trials is an affordable health care system in which most of the children with cancer can receive the proposed treatment. The health insurance coverage for children with cancer varies from <20% to as high as 100% among Asian countries, and the operation of clinical trials must also be adjusted accordingly. Shortage of research personnel is common, including medical, nursing, research coordinators, and data managers. The establishment of the Asian Pediatric Hematology and Oncology Group aims to provide a good platform for promotion of international clinical trials in the Asian countries.
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Affiliation(s)
- Chi-kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Purna Kurkure
- Division of Pediatric Hemato Oncology & BMT, SRCC Children's Hospital Haji Ali, Mumbai, India
| | - Ramandeep Singh Arora
- Pediatric Oncology Disease Management Group, Max Super Specialty Hospital, New Delhi, India
| | - Bow Wen Chen
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Kirill Kirgizov
- N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Yasuhiro Okamoto
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka Kagoshima, Japan
| | - Panya Seksarn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yongmin Tang
- Department of Hematology-Oncology, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bharat Agarwal
- Department of Pediatric Hematology & Oncology, B J Wadia Hospital for Children, Parel, Mumbai, India
| | - Godfrey C.F. Chan
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Rashmi Dalvi
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Bombay, India
| | - Hiroki Hori
- Graduate School of Medicine, Mie University in Tsu, Tsu, Japan
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Kingdom of Saudi Arabia
| | - Alice Yu
- Institute of Stem Cell & Translational Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Akira Nakagawara
- Saga International Carbon Particle Beam Radiation Cancer Therapy Center, Saga HIMAT Foundation, Harakoga-Machi, Saga, Japan
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Kalra M, Bakhshi S, Singh M, Seth R, Verma N, Jain S, Radhakrishnan V, Mandal P, Mahajan A, Arora RS, Dinand V, Kapoor G, Sajid M, Kumar R, Taluja A, Mallick S, Chandra J. Response assessment by positron emission tomography-computed tomography as compared with contrast-enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low- and middle-income countries. Pediatr Blood Cancer 2023; 70:e30091. [PMID: 36411263 DOI: 10.1002/pbc.30091] [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: 08/03/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The InPOG-HL-15-01, a multicentric prospective study, used a risk-stratified and response-based approach with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) backbone to treat children and adolescents with newly diagnosed Hodgkin lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after two cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast-enhanced computed tomography (CECT) and PET-CT on treatment decisions and outcomes. METHODOLOGY 396 patients were enrolled and 382 had an ERA at the assigned time point. Satisfactory response was defined as Deauville score 3 or less for patients undergoing PET-CT and complete response (CR)/very good partial response (VGPR) for patients undergoing CECT. Outcomes of interest incorporate 5 year event-free survival (EFS), EFS including abandonment (EFSa), and overall survival (OS). RESULTS At ERA, satisfactory response was documented in 277 out of 382 (72.5%) participants and this was significantly higher in PET-CT (151 out of 186, 81.2%) as compared with CECT-based assessments (126 out of 196, 64.3%) respectively (p value < .001). Amongst the 203 patients with nonbulky disease (wherein the indication for RT was entirely dependent on ERA), 96 out of 114 (84.2%) and 61 out of 89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value = .008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year OS of both groups, ERA based on CECT (91.8%) versus PET-CT (94.1%) was comparable (p value = .391) and so was the 5 year EFS (86.7 vs. 85.5%, p value = .724). CONCLUSION Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared with CECT and thereby decreases the need for RT in response-based treatment algorithm for HL-afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.
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Affiliation(s)
- Manas Kalra
- Department of Pediatric Hematology Oncology BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - M Singh
- Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Sandeep Jain
- Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
| | - V Radhakrishnan
- Department of Pediatric Oncology, Cancer Institute, Adyar, Chennai, India
| | - Piali Mandal
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
| | - Amita Mahajan
- Department of Pediatric Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Ramandeep S Arora
- Department of Pediatric Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Veronique Dinand
- Department of Palliative and Supportive Unit, BJ Wadia Hospital, Mumbai, India
| | - Gauri Kapoor
- Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
| | - M Sajid
- Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Taluja
- Cankids Kidscan, New Delhi, India
| | - Saumyaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
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Clinical and Prognostic Impact of Copy Number Alterations and Associated Risk Profiles in a Cohort of Pediatric B-cell Precursor Acute Lymphoblastic Leukemia Cases Treated Under ICiCLe Protocol. Hemasphere 2022; 6:e782. [PMID: 36204689 PMCID: PMC9529051 DOI: 10.1097/hs9.0000000000000782] [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: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022] Open
Abstract
Copy number alteration (CNA) status and CNA risk profiles of IKZF1plus, UK-ALL CNA risk groups and MRplus scores, were evaluated for clinical and prognostic impact in a cohort of 493 B-cell acute lymphoblastic leukemia cases diagnosed and treated under the Indian Collaborative Childhood Leukemia group (ICiCLe) protocol trial. Overall CNA frequency was 59% with 60% of cases showing 2-loci deletion. CDKN2A/B deletion was most common CNA (36.3%), while IKZF1 deletion and IKZF1plus profile were noted in 19.5% and 13.4% of cases, respectively. IKZF1 deletions and other CNA risk profiles were significantly associated with poor (PR)/high risk (HR) clinical and genetic profile parameters (P < 0.001). In addition, the 3-year OS, event-free survival (EFS) was significantly poor with high relapse rate (RR) of 38.6%, 46.5%, and 35.2% for IKZF1 deletions, IKZF1plus profiles, and UK-ALL CNA-intermediate risk (IR)+PR risk groups, respectively (P < 0.001). Integrated evaluation of UK-ALL CNA risk profile with ICiCLe trial risk stratification groups revealed a worse overall survival, EFS, and RR of 63.3%, 43.2%, and 35.2% for CNA-IR+PR profile compared to CNA-good risk profile (81.3%, 65.0%, and 21.0%; P < 0.001). Hence, routine CNA testing in our setting is must to identify standard risk and IR cases likely to benefit from HR treatment.
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Gupta S. Using data to improve care: childhood cancer in China. Lancet 2022; 400:977-979. [PMID: 36154678 DOI: 10.1016/s0140-6736(22)01796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada.
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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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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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Cr V, Das G, Seth R, Sapra S, Sri P, Meena JP, Gupta AK, Sreenivas V. Neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia: Experience from a tertiary care center in India. Pediatr Blood Cancer 2022; 69:e29688. [PMID: 35403813 DOI: 10.1002/pbc.29688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data of neurocognitive deficits in survivors of acute lymphoblastic leukemia (ALL) is scarce from low middle-income countries (LMICs), and is influenced by biological and cultural variations. The objective of this study was to assess the prevalence and spectrum of neurocognitive deficits in a cohort of survivors from India. PROCEDURE Seventy survivors of childhood ALL were evaluated for neurocognitive deficits by the Indian adaptation of Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IVINDIA ). The prevalence of neurocognitive deficits was calculated based on the full-scale intelligence quotient (FSIQ), and scores in discrete domains like verbal comprehension, perceptual reasoning, working memory, and processing speed were calculated and compared to demographics, treatment, and sociocultural factors. RESULTS The mean (SD) current age and time since diagnosis was 10.5 (±3.2) years and 5 (±2.8) years, respectively. The mean FSIQ was 86.1 ± 20.5, with significant neurocognitive deficit (FSIQ <90) being prevalent in 50% (95% CI: 38%-62%) of the cohort. The proportion of survivors with deficits in individual domains of verbal comprehension, perceptual reasoning, working memory, and processing speed were 49%, 50%, 47%, and 44%, respectively. The odds of having neurocognitive deficits were higher when a child belonged to lower socioeconomic strata (OR 5.7, p = .004), parents with lower education attainment (OR 4.3, p = .041), and whose birth order was higher (OR 20.1, p = .005). Age at diagnosis/assessment, chemotherapy received, or dose of radiotherapy did not have a direct impact on neurocognition. CONCLUSIONS AND RELEVANCE Rates of neurocognitive deficits are higher in survivors in LMICs, with socioeconomic variables contributing more than the direct neurotoxic effects of treatment.
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Affiliation(s)
- Vishwa Cr
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Gargi Das
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Sapra
- Division of Child Psychology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Prasanth Sri
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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12
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Major A, Palese M, Ermis E, James A, Villarroel M, Klussmann FA, Hessissen L, Geel J, Khan MS, Dalvi R, Sullivan M, Kearns P, Frazier AL, Pritchard-Jones K, Nakagawara A, Rodriguez-Galindo C, Volchenboum SL. Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage. JCO Glob Oncol 2022; 8:e2100266. [PMID: 35157510 PMCID: PMC8853619 DOI: 10.1200/go.21.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer. Local stakeholder engagement is necessary to collaborate with global pediatric cancer trial groups.![]()
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Affiliation(s)
- Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Monica Palese
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Ebru Ermis
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Anthony James
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Milena Villarroel
- Grupo de América Latina de Oncología Pediátrica (GALOP), Hospital Luis Calvo Mackenna, National Pediatric Cancer Program (PINDA), Santiago, Chile
| | - Federico Antillon Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Laila Hessissen
- Pediatric Hematology and Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Saudi Arabia
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
| | | | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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13
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Jain S, Bakhshi S, Seth R, Verma N, Singh M, Mahajan A, Radhakrishnan V, Mandal P, Arora R, Dinand V, Kalra M, Sharma A, Taluja A, Thulkar S, Biswas A, Chandra J. Risk based and response adapted radiation therapy for children and adolescents with newly diagnosed advanced stage Hodgkin lymphoma treated with ABVD chemotherapy: a report from the Indian pediatric oncology group study InPOG-HL-15-01. Leuk Lymphoma 2021; 63:1111-1118. [PMID: 34881686 DOI: 10.1080/10428194.2021.2012659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This multi-centric prospective study (InPOG-HL-15-01) assessed epidemiological, clinical and outcome data of advanced stage Hodgkin Lymphoma (IIB, III and IV) in children and adolescents (N = 262). Chemotherapy regimen was ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiotherapy (RT) was restricted to patients with bulky disease at diagnosis or with suboptimal response at early response assessment (ERA). ERA revealed complete response in 175 (68.1%), partial response in 77 (29.9%), stable disease in 2 (0.8%), and progressive disease in 3 (1.2%) patients. RT was administered to 111 (97 bulky disease, 14 suboptimal response) patients. Five-year event free (EFS) and overall survival for the whole cohort was 81.1% and 90.8% respectively. On multivariate analysis, the only statistically significant predictor of EFS was use of RT (89% versus 74.2%; p-value <0.001). This study reinforces the benefit of consolidative RT in bulky disease and in those with suboptimal response at ERA on an ABVD backbone.
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Affiliation(s)
- Sandeep Jain
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sameer Bakhshi
- Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Verma
- Pediatrics, King George Medical University, Lucknow, India
| | - Manisha Singh
- Medical and Pediatric Oncology, Mahavir Cancer Sansthan and Research Centre, Patna, India
| | - Amita Mahajan
- Pediatric Oncology, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | | | - Piali Mandal
- Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Veronique Dinand
- Palliative and Supportive Unit, Bai Jerbai Wadia Hospital for Children, Parel, India
| | - Manas Kalra
- Pediatric Hematology Oncology and BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Sharma
- Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Sanjay Thulkar
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Radiations Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Chandra
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
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14
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Kiwumulo HF, Muwonge H, Ibingira C, Kirabira JB, Ssekitoleko RT. A systematic review of modeling and simulation approaches in designing targeted treatment technologies for Leukemia Cancer in low and middle income countries. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:8149-8173. [PMID: 34814293 DOI: 10.3934/mbe.2021404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Virtual experimentation is a widely used approach for predicting systems behaviour especially in situations where resources for physical experiments are very limited. For example, targeted treatment inside the human body is particularly challenging, and as such, modeling and simulation is utilised to aid planning before a specific treatment is administered. In such approaches, precise treatment, as it is the case in radiotherapy, is used to administer a maximum dose to the infected regions while minimizing the effect on normal tissue. Complicated cancers such as leukemia present even greater challenges due to their presentation in liquid form and not being localised in one area. As such, science has led to the development of targeted drug delivery, where the infected cells can be specifically targeted anywhere in the body. Despite the great prospects and advances of these modeling and simulation tools in the design and delivery of targeted drugs, their use by Low and Middle Income Countries (LMICs) researchers and clinicians is still very limited. This paper therefore reviews the modeling and simulation approaches for leukemia treatment using nanoparticles as an example for virtual experimentation. A systematic review from various databases was carried out for studies that involved cancer treatment approaches through modeling and simulation with emphasis to data collected from LMICs. Results indicated that whereas there is an increasing trend in the use of modeling and simulation approaches, their uptake in LMICs is still limited. According to the review data collected, there is a clear need to employ these tools as key approaches for the planning of targeted drug treatment approaches.
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Affiliation(s)
| | - Haruna Muwonge
- Department of Medical Physiology, Makerere University, Kampala, Uganda
| | - Charles Ibingira
- Department of Human Anatomy, Makerere University, Kampala, Uganda
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15
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van Heerden J, Hendricks M, Poole J, Büchner A, Naidu G, du Plessis J, van Emmenes B, van Zyl A, Uys R, Johani J, Hadley GP, Harrison D, Rowe B, Bassingthwaighte M, Moonsamy N, Kruger M. The implementation of a national paediatric oncology protocol for neuroblastoma in South Africa. Cancer Causes Control 2021; 32:725-737. [PMID: 33881651 PMCID: PMC8058747 DOI: 10.1007/s10552-021-01424-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of the World Health Organization-International Paediatric Oncology Society is to improve childhood cancer survival in low- and middle-income countries to 60% by 2030. This can be achieved using standardised evidence-based national treatment protocols for common childhood cancers. The aim of the study was to describe the development and implementation of the SACCSG NB-2017 neuroblastoma (NB) treatment protocol as part of the treatment harmonisation process of the South African Children’s Cancer Study Group. Methods The Consolidated Framework for Implementation Research was used to identify factors that could influence the implementation of the national NB protocol as a health care intervention. The evaluation was done according to five interactive domains for implementation: intervention characteristics, inner setting, outer setting, individual or team characteristics and the implementation process. Results The protocol was developed over 26 months by 26 physicians involved in childhood cancer management. The process included an organisational phase, a resource identification phase, a development phase and a research ethics approval phase. Challenges included nationalised inertia, variable research ethical approval procedures with delays and uncoordinated clinical trial implementation. Conclusion The implementation of the national NB protocol demonstrated the complexity of the implementation of a national childhood cancer treatment protocol. However, standardised paediatric cancer treatment protocols based on local expertise and resources in limited settings are feasible. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01424-2.
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Affiliation(s)
- Jaques van Heerden
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa. .,Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium.
| | - Marc Hendricks
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Paediatric Haematology and Oncology Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Janet Poole
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Ané Büchner
- Paediatric Haematology and Oncology, Department of Paediatrics, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Gita Naidu
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Jan du Plessis
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Faculty of Health Sciences, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
| | - Barry van Emmenes
- Division of Paediatric Haematology and Oncology Hospital, Department of Paediatrics, Frere Hospital, East London, South Africa
| | - Anel van Zyl
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Ronelle Uys
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Johani Johani
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - G P Hadley
- Department of Paediatric Surgery, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Derek Harrison
- Faculty of Health Sciences, Department of Paediatric Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Biance Rowe
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Mairi Bassingthwaighte
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nicolene Moonsamy
- Department of Paediatric Haematology and Oncology, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Academic Hospital, Durban, South Africa
| | - Mariana Kruger
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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16
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Behan JM, Arora RS, Carnevale FA, Bakhshi S, Bhattacharjee B, Tsimicalis A. An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India. Glob Qual Nurs Res 2021; 8:2333393621995814. [PMID: 33748333 PMCID: PMC7905724 DOI: 10.1177/2333393621995814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/15/2022] Open
Abstract
There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.
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Affiliation(s)
| | | | | | - Sameer Bakhshi
- All India Institute of Medical Sciences, New Delhi, India
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17
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Arora RS, Raj R, Mahajan A, Radhakrishnan N, Chinnaswamy G, Banavali S. Collaborative cancer research: progress report from the Indian Pediatric Oncology Group. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:239-240. [PMID: 33743204 DOI: 10.1016/s2352-4642(21)00056-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ramandeep Singh Arora
- Pediatric Oncology Disease Management Group, Max Super Speciality Hospital, New Delhi 110017, India.
| | - Revathi Raj
- Department of Hematology and Hemato-Oncology, Apollo Specialty Hospital, Chennai, India
| | - Amita Mahajan
- Department of Pediatrics Oncology and Hematology, Indraprastha Apollo Hospital, New Delhi, India
| | - Nita Radhakrishnan
- Department of Pediatric Hematology-Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, India
| | - Girish Chinnaswamy
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India; Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India; Health Sciences, Homi Bhabha National Institute, Mumbai, India
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18
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Faruqui N, Bernays S, Martiniuk A, Abimbola S, Arora R, Lowe J, Denburg A, Joshi R. Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage. BMC Public Health 2020; 20:1641. [PMID: 33143668 PMCID: PMC7607709 DOI: 10.1186/s12889-020-09758-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia
| | - Ramandeep Arora
- Cankids … Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,George Institute for Global Health, New Delhi, India
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19
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Gupta S, Hunger SP. Recent trends in the results of studies conducted by the Children’s Oncology Group acute lymphoblastic leukemia committee and implications for emerging cooperative trial groups in low- and middle-income countries. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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20
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Radhakrishnan N. When drops become an ocean. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Arora RS, Mahajan A, Dinand V, Kalra M, Jain S, Taluja A, Mandal P, Chandra J. InPOG-HL-15-01 - Challenges and lessons learnt in setting up the first collaborative multicentre prospective clinical trial in childhood cancer in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Arora RS, Arora PR, Seth R, Sharma S, Kumar C, Dhamankar V, Kurkure P, Prasad M. Childhood cancer survivorship and late effects: The landscape in India in 2020. Pediatr Blood Cancer 2020; 67:e28556. [PMID: 32649000 DOI: 10.1002/pbc.28556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 01/05/2023]
Abstract
Survivorship care is a major area of focus in the holistic management of childhood cancer with current knowledge and information almost exclusively from high-income countries. In this review, we summarize the state of scientific knowledge, service delivery, advocacy initiatives, and research efforts in this field in India. Twenty-one single-center studies published until today (20 in the last decade) confirm some of the well-documented issues in childhood cancer survivors and highlight the high prevalence of hepatitis B and hepatitis C infection in our survivors. Heterogeneity in methodology, outcome metrics, and quality precludes drawing further conclusions, and the ongoing multicenter Indian Pediatric Oncology Group study would address this. Besides the usual model of follow-up clinics in hospital settings, innovative models of service delivery led by not-for-profit organizations are being developed. Advocacy initiatives driven by survivors and support groups are also under way. All of these portend a promising future.
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Affiliation(s)
- Ramandeep Singh Arora
- Pediatric Oncology Disease Management Group, Max Super Speciality Hospital Saket, New Delhi, 110017, India.,Cankids, New Delhi, India
| | | | - Rachna Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Purna Kurkure
- Indian Cancer Society, Mumbai, India.,Narayana Health SRCC Children's Hospital, Mumbai, India
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23
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Ganguly S, Kinsey S, Bakhshi S. Childhood cancer in India. Cancer Epidemiol 2020; 71:101679. [PMID: 32033883 DOI: 10.1016/j.canep.2020.101679] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
India has made significant improvement in childhood cancer services in last few decades. However, the outcome still remains modest as compared to global standards due to significant barriers in recognition, diagnosis and cure. Data regarding comprehensive childhood cancer burden in country is lacking due to low and urban predominant coverage of population-based cancer registry programs. The available data shows lower incidence of childhood cancer incidence especially in leukaemia and CNS tumours which may suggest poor awareness of caregivers and delayed diagnosis with many "missed cases". Incidence data are also skewed towards male preponderance which suggests gender bias in seeking healthcare. The childhood cancer services in India are predominantly restricted to few tertiary care centres in major cities. The outcome in major groups of cancer is complicated by delayed and more advanced stage of presentation and poor supportive care during intensive treatment. Treatment refusal and abandonment remains major hurdles. Last few decades saw development of dedicated paediatric oncology services and training programs in the country. The development of InPOG (Indian Paediatric Oncology group) for conducting collaborative trials will lead to adoption of uniform treatment protocols suited for the country. Financial support through the government promoted health insurance and holistic support through philanthropic organizations have improved treatment adherence and outcome. Moving forward, the focus should be on strengthening the cancer registries for capturing nationwide data, improving awareness of childhood cancer among caregivers and healthcare workers for early recognition and improving accessibility of childhood cancer care services beyond major cities.
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Affiliation(s)
| | - Sally Kinsey
- Department of Paediatric Haematology, University of Leeds, Honorary Consultant Paediatric Haematologist, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Sameer Bakhshi
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India.
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24
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Papyan R, Tamamyan G, Danielyan S, Tananyan A, Muradyan A, Saab R. Identifying barriers to treatment of childhood rhabdomyosarcoma in resource-limited settings: A literature review. Pediatr Blood Cancer 2019; 66:e27708. [PMID: 30907501 DOI: 10.1002/pbc.27708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 11/11/2022]
Abstract
We performed a literature review to examine barriers for rhabdomyosarcoma treatment in low-resource settings, and identified 29 articles from 14 middle-income countries, with none from low-income countries. Notable findings included inconsistent use of local control modalities, lack of diagnostics in some settings, and high rate of abandonment specifically in low middle-income countries. Reported limitations included lack of surgical expertise and/or radiation therapy, advanced stage of disease, and absence of health insurance. Although very poor outcomes were prevalent in several settings, good outcomes were achievable in others when multidisciplinary therapy and financial coverage of medical care were made available.
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Affiliation(s)
- Ruzanna Papyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
| | - Gevorg Tamamyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia.,Master in Advanced Oncology Program, University of Ulm, Ulm, Germany
| | - Samvel Danielyan
- Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia.,Hematology Center, Yerevan, Armenia
| | - Armen Tananyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,National Oncology Center, Yerevan, Armenia
| | - Armen Muradyan
- Department of Urology, Yerevan State Medical University, Yerevan, Armenia
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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25
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Howard SC, Davidson A, Luna-Fineman S, Israels T, Chantada G, Lam CG, Hunger SP, Bailey S, Ribeiro RC, Arora RS, Pedrosa F, Harif M, Metzger ML. A framework to develop adapted treatment regimens to manage pediatric cancer in low- and middle-income countries: The Pediatric Oncology in Developing Countries (PODC) Committee of the International Pediatric Oncology Society (SIOP). Pediatr Blood Cancer 2017; 64 Suppl 5. [PMID: 29297619 DOI: 10.1002/pbc.26879] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 01/25/2023]
Abstract
Many children with cancer in low- and middle-income countries are treated in hospitals lacking key infrastructure, including diagnostic capabilities, imaging modalities, treatment components, supportive care, and personnel. Childhood cancer treatment regimens adapted to local conditions provide an opportunity to cure as many children as possible with the available resources, while working to improve services and supportive care. This paper from the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology outlines the design, development, implementation, and evaluation of adapted regimens and specifies levels of services needed to deliver them.
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Affiliation(s)
- Scott C Howard
- University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Alan Davidson
- Haematology-Oncology Service, Red Cross Children's Hospital, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Sandra Luna-Fineman
- Hematology/Oncology/SCT, Center for Global Health, Children, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Trijn Israels
- Department of Paediatric Oncology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Guillermo Chantada
- CONICET, Buenos Aires, Argentina.,Pediatric Hemato-Oncology, Hospitals JP Garrahan and Austral, Buenos Aires, Argentina.,Hemato-Oncology Service, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Catherine G Lam
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephen P Hunger
- Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simon Bailey
- Paediatric Neuro-Oncology and Paediatric Oncology, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | | | - Mhamed Harif
- Department of Hematology, Hôpital 20 août, Casablanca, Morocco
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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26
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Is Pre-operative Chemotherapy Desirable in all Patients of Wilms' Tumor? Indian J Pediatr 2017; 84:709-714. [PMID: 28687950 DOI: 10.1007/s12098-017-2410-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
The timing and role of chemotherapy in the management of Wilms' tumor has long been the matter of debate, with different groups showing equally comparable and encouraging results. Over the last decade, however, both the ideol-ogies seem to be converging and the attempt has been to identify groups benefitting with pre-operative chemotherapy, as well as those, where upfront resection should be attempted. In this article authors intend to discuss pros and cons of both the strategies and their applicability in a resource poor setting in developing countries like India.
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27
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Tiwari A, Bakhshi S. Editorial: Indian Guidelines for Treatment of Pediatric Malignancies. Indian J Pediatr 2017; 84:369-370. [PMID: 28299539 DOI: 10.1007/s12098-017-2334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Akash Tiwari
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.
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28
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Pediatric Hematopoietic Stem Cell Transplantation in India: Status, Challenges and the Way Forward : Based on Dr. K. C. Chaudhuri Oration 2016. Indian J Pediatr 2017; 84:36-41. [PMID: 27832477 DOI: 10.1007/s12098-016-2253-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 01/31/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) refers to therapies that aim to eliminate a patient's hematopoietic and immune system and replace it with his own (autologous) or someone else's (allogenic) system. The applications of this therapy are vast and growing, and include several malignant and benign diseases incurable by any other existing modalities. Pediatric patients constitute a minority of HSCT recipients with unique concerns. Despite substantial progress in the last two decades, limitations due to financial, infrastructural, manpower and research constraints act as barriers to fulfilling the large need for pediatric HSCT services in our country. Limited availability of unrelated donors and cord blood units is another constraint. Here in this oration, we discuss the current issues pertaining to pediatric HSCT in India and describe our experience with the same.
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