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Gwanika Y, Rice HE, Metcalf M, Espinoza P, Kajoka HD, Rice HE, Staton C, Mmbaga BT, Majaliwa E, Smith ER, Cotache-Condor C. Impact of the COVID-19 pandemic in childhood and adolescent cancer care in northern Tanzania: a cross-sectional study. BMC Cancer 2024; 24:457. [PMID: 38609910 PMCID: PMC11010397 DOI: 10.1186/s12885-024-12168-y] [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: 12/08/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. METHODS In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0-19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016-2019) and COVID-19 (2020-2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. RESULTS Overall admissions nearly doubled during the pandemic (n = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% (p < 0.001). CONCLUSION Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.
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Affiliation(s)
- Yotham Gwanika
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Hannah E Rice
- Duke Primary Care, Population Health, Duke University, Durham, NC, USA
| | | | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Happiness D Kajoka
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
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Siddiqui AK, Belgaumi AF. Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges. Ecancermedicalscience 2024; 18:1677. [PMID: 38439809 PMCID: PMC10911667 DOI: 10.3332/ecancer.2024.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 03/06/2024] Open
Abstract
The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.
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Affiliation(s)
- Arsalan Kabir Siddiqui
- All authors have contributed to this manuscript and take responsibility for its contents
| | - Asim Fakhruddin Belgaumi
- All authors have contributed to this manuscript and take responsibility for its contents
- https://orcid.org/0000-0002-0135-7509
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Soliman R, Bolous N, Heneghan C, Oke J, Boylan AM, Eweida W, Abouelnaga S, Elhaddad A. An overview of childhood cancer care and outcomes in Egypt: a narrative review. Ecancermedicalscience 2024; 18:1676. [PMID: 38439811 PMCID: PMC10911675 DOI: 10.3332/ecancer.2024.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 03/06/2024] Open
Abstract
Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.
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Affiliation(s)
- Ranin Soliman
- Health Economics and Value Unit, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Centre for Evidence-Based Medicine, University of Oxford, OX1 2JD Oxford, UK
- Co-first authors
| | - Nancy Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Co-first authors
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Anne-Marie Boylan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
| | - Sherif Abouelnaga
- Chief Executive Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- Paediatric Oncology Department, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
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Tang S, Jones C, Mecca R, Davies J, Lane S, Coward K. An in vitrothree-dimensional (3D) testicular organoid culture system for efficient gonocyte maintenance and propagation using frozen/thawed neonatal bovine testicular tissues. Biomed Mater 2024; 19:025040. [PMID: 38324899 DOI: 10.1088/1748-605x/ad2709] [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: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 02/09/2024]
Abstract
Fertility preservation in prepubertal boys with cancer requires the cryopreservation of immature testicular tissues (ITTs) prior to gonadotoxic treatment. However, the limited number of germ cells in small human ITT biopsies necessitates the development of anin vitroculture system for germ cell expansion using frozen-thawed ITTs. Here, we generated testicular organoids for thein vitromaintenance and expansion of gonocytes from frozen-thawed two-week-old neonatal bovine ITTs. We investigated the effects of different cell-seeding densities, culture serums, seeding methods, and gonadotropin supplementations, on the maintenance and proliferation of enriched gonocytes. Our results demonstrated that enriched gonocytes and testicular cells from frozen-thawed neonatal ITTs could self-assemble into spheroid organoids in three days in an appropriate Matrigel-based culture environment. For the optimal formation of prepubertal testicular organoids, a seeding density of 1 × 106cells/well is recommended over other densities. This strategy results in organoids with a mean diameter of 60.53 ± 12.12 μm; the mean number of organoids was 5.57 ± 1.60/105μm2on day 11. The viability of organoids was maintained at 79.75 ± 2.99% after being frozen and thawed. Supplementing the culture medium with glial cell-derived neurotrophic factor, fibroblast growth factor 2, and leukemia inhibitory factor, increased the proportion of KI67-positive proliferating cells in organoids, elevated the expression ofC-KITbut reduced the expression ofGFRα1at day 28 when compared to those without hormone supplements(p< 0.05). In addition, supplementing the culture medium with follicle-stimulating hormone and testosterone helped to maintain a significantly higher viability (p< 0.05) in ITT organoids at day 28. These organoids could be cryopreserved for storage and thawed as needed. The successful generation of ITT organoids provides a valuable tool for establishingin vitrospermatogenesis, propagating human germ cells, investigating testicular physiology and the origin of germ cell tumors, and testing the toxicity of new drugs in future clinical applications.
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Affiliation(s)
- Shiyan Tang
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 0AG, United Kingdom
- Present address: Radcliffe Department of Medicine, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, United Kingdom
| | - Celine Jones
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 0AG, United Kingdom
| | - Rajwa Mecca
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 0AG, United Kingdom
| | - Jill Davies
- Oxford Cell and Tissue Biobank, Children's Hospital Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, Children's Hospital Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Kevin Coward
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 0AG, United Kingdom
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Hayashi H, Makimoto A, Yuza Y. Treatment of Pediatric Acute Lymphoblastic Leukemia: A Historical Perspective. Cancers (Basel) 2024; 16:723. [PMID: 38398113 PMCID: PMC10887299 DOI: 10.3390/cancers16040723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common disease in pediatric oncology. The history of developmental therapeutics for ALL began in the 1960s with the repetition of "unreliable" medical interventions against this lethal disease. By the 1990s, the development of multi-agent chemotherapy and various types of supportive care rendered ALL treatable. Highly sophisticated, molecular, diagnostic techniques have enabled highly accurate prediction of the relapse risk, and the application of risk-adapted treatments has increased the survival rate in the standard-risk group to nearly 100% in most European nations and North America. Incorporation of state-of-the-art, molecularly targeted agents and novel treatments, including cell and immunotherapy, is further improving outcomes even in the high-risk group. On the other hand, the financial burden of treating children with ALL has increased, imperiling the availability of these diagnostic and treatment strategies to patients in low- and middle-income countries (LMICs). The fundamental treatment strategy, consisting of corticosteroid and classical cytotoxic therapy, has achieved fairly good outcomes and should be feasible in LMICs as well. The present review will discuss the history of developmental therapeutics for childhood ALL in various countries through an extensive literature review with the aim of proposing a model for a treatment backbone for pediatric ALL. The discussion will hopefully benefit LMICs and be useful as a base for future clinical trials of novel treatments.
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Affiliation(s)
- Hiroshi Hayashi
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
| | - Atsushi Makimoto
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
- Department of Laboratory Medicine, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan
| | - Yuki Yuza
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
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Monko DJ, Martin HD, Mpolya EA. Correlating food and nutritional patterns with cancers in the pediatric oncology population at two specialized hospitals in Tanzania. BMC Nutr 2024; 10:10. [PMID: 38212830 PMCID: PMC10782733 DOI: 10.1186/s40795-024-00824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study of nutritional patterns in relation to cancers among pediatric oncology population in Tanzania was motivated by the lack of up-to-date information about the nutritional practices, the controversy around the importance of nutritional support and the lack of consistent nutritional criteria among pediatric oncology populations. METHODS A survey study in two cancer referral hospitals of children diagnosed with any cancers, aged between 1 and 17 years inclusive and being eligible for enteral feeding included 131 children. Their demographic, nutritional, feeding and cancer profiles were analyzed descriptively through mapping and other approaches as well as inferentially using multinomial regression models to understand different aspects of nutrition for children suffering from cancers. RESULTS The majority (15% or higher) of pediatric oncology population originated from the lake zone. Between 7 and 12% of pediatric oncology population originated from the Western zone. The top-three cancers with their percentages in the brackets were: Wilms Tumor (32%), Acute Lymphoblastic Leukemia (26%) and Retinoblastoma (13%). About 69% of the pediatric oncology population ate foods that are rich in energy but poor in protein such as rice (21.5%), porridge (19.3%), banana (11.7%) and potatoes (10.2%). On the other hand, only 17.5% ate foods that are generally protein-rich such as meat (8.0%), fish (5.3%) and chicken (4.2%); and 12.7% ate milk (4.2%), beans (3.4%), vegetables (2.7%), eggs (1.9%) and fruits (1.5%). Cancers impacted food intake in about 60% of all children with cancers and affected appetite in 18.3% of them. Cancers caused vomiting in 16% and diarrhea in 6.1% of children. The majority of children with cancers (61.8%) took at least one meal while 34.4% took just snacks (p < 0.001). CONCLUSIONS The majority of pediatric oncology population had erratic nutritional patterns and took foods high in energy and poor in proteins. There is a two-way interaction between cancers and nutrition in which cancers affect general nutritional intake which could affect the cancer treatment outcomes in return. Therefore, it is important to consider these interactions while managing pediatric oncology populations in this and similar settings.
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Affiliation(s)
- Dafrosa Joseph Monko
- Department of Food and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania.
- Bugando Medical Center, Wurzburg Street, 1370, Mwanza, Tanzania.
| | - Haikael David Martin
- Department of Food and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania
| | - Emmanuel Abraham Mpolya
- Department of Global Health and Bio-Medical Sciences, S chool of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania
- Institute of Bioaffiliationersity, Animal Health & Comparative Medicine, University of Glasgow, G12 8QQ, Glasgow, Scotland, UK
- Center for Global Health (CGH), Perelman School of Medicine, University of Pennsylvania, 240 John Morgan Bldg, 3620, 19104, Hamilton Walk, Philadelphia, PA, USA
- Institute for Health Metrics and Evaluation, Population Health Building/Hans Rosling Center, 3980 15th Ave. NE, UW Campus Box #351615, 98195, Seattle, WA, USA
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Nishath T, Li X, Chandramohan A, Othus M, Ji X, Zou Y, Sultana S, Rashid R, Sherief ST, Cassoux N, Garcia Leon JL, Díaz Coronado R, López AMZ, Ushakova TL, Polyakov VG, Roy SR, Ahmad A, Reddy A, Sagoo MS, Al Harby L, Kim JW, Berry JL, Polski A, Astbury N, Bascaran C, Blum S, Bowman R, Burton MJ, Foster A, Gomel N, Keren-Froim N, Madgar S, Zondervan M, Kaliki S, Fabian ID, Stacey A. Risk factors associated with abandonment of care in retinoblastoma: analysis of 692 patients from 10 countries. Br J Ophthalmol 2023; 107:1818-1822. [PMID: 36113955 PMCID: PMC10017370 DOI: 10.1136/bjo-2022-321159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of care abandonment for retinoblastoma (RB) demonstrate significant geographical variation; however, other variables that place a patient at risk of abandoning care remain unclear. This study aims to identify the risk factors for care abandonment across a multinational set of patients. METHODS A prospective, observational study of 692 patients from 11 RB centres in 10 countries was conducted from 1 January 2019 to 31 December 2019. Multivariate logistic regression was used to identify risk factors associated with higher rates of care abandonment. RESULTS Logistic regression showed a higher risk of abandoning care based on country (high-risk countries include Bangladesh (OR=18.1), Pakistan (OR=45.5) and Peru (OR=9.23), p<0.001), female sex (OR=2.39, p=0.013) and advanced clinical stage (OR=4.22, p<0.001). Enucleation as primary treatment was not associated with a higher risk of care abandonment (OR=0.59, p=0.206). CONCLUSION Country, advanced disease and female sex were all associated with higher rates of abandonment. In this analysis, enucleation as the primary treatment was not associated with abandonment. Further research investigating cultural barriers can enable the building of targeted retention strategies unique to each country.
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Affiliation(s)
- Thamanna Nishath
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Xiudi Li
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Arthika Chandramohan
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan Othus
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, Universite de Paris UFR de Medecine de Paris Centre, Paris, France
| | | | | | | | - Tatiana L Ushakova
- Head and Neck Tumors, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Pediatric Oncology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Soma Rani Roy
- Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh
| | - Alia Ahmad
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Ashwin Reddy
- Ophthalmology, Barts Health NHS Trust, London, UK
- Paediatric Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- Ophthalmology, Barts Health NHS Trust, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Joint Library of Ophthalmology Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Lamis Al Harby
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Jonathan W Kim
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jesse L Berry
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ashley Polski
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nick Astbury
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Cova Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Matthew J Burton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Allen Foster
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, and International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nir Gomel
- Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
- Division of Ophthalmology, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Naama Keren-Froim
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Shiran Madgar
- Ophthalmology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Stacey
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
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Farrag A, Ghazaly MH, Mohammed K, Volland R, Hero B, Berthold F. Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country. BMC Pediatr 2023; 23:443. [PMID: 37670249 PMCID: PMC10478379 DOI: 10.1186/s12887-023-04214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC). METHODS A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors. RESULTS The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma. CONCLUSIONS Outcome differences were associated with different causes of death and other less prominent factors.
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Affiliation(s)
- Ahmed Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
| | | | - Khaled Mohammed
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Volland
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Statistics, University Hospital of Cologne, Cologne, Germany
| | - Barbara Hero
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
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9
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Nath A, Mathur P, Sudarshan K, Kaur Rajput G, Mascarenhas L, Arora RS, Seth R, Kumar Dixit S, Chinnaswamy G, Banipal RPS, Bhutia TW, Kumar Bodal V, Budukh A, Kumar Chaudhary N, Vijay C, Shikha Das D, Gundeti S, Harris C, Hazarika M, Natha Jondhale S, Gunaseelan K, Khamo V, Konjengbam R, Kumar A, Saroj Kumar DM, Majumdar G, Malik S, Mandal S, Najmi AM, Mohan Kumar C, Kumar Pandey A, Pandya S, Pareek P, Pautu JL, Surya Rao V, Ramesh C, Rawal M, Radhakrishnan N, Radhakrishnan V, Shah A, Singh S, Singh V, Singh P, Sundriyal D, Swaminathan R, Avinash T, Priya Kumari T, Tawsik S, Tiwari L. An assessment of childhood cancer care services in India - gaps, challenges and the way forward. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100235. [PMID: 37694177 PMCID: PMC10485780 DOI: 10.1016/j.lansea.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 09/12/2023]
Abstract
Background Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design. Methods The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean. Findings A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals. Interpretation The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally. Funding World Health Organization, India provided funding and technical support.
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Affiliation(s)
- Anita Nath
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - K.L. Sudarshan
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Gurpreet Kaur Rajput
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Leena Mascarenhas
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | | | - Rachna Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Tseten W. Bhutia
- Sir Thutob Namgyal Memorial Referral Hospital, Gangtok, Sikkim, India
| | | | - Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - C.R. Vijay
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | | | - Caleb Harris
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | | | | | - K. Gunaseelan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Arun Kumar
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | | | - Shikha Malik
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Arshad Manzoor Najmi
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | | | - Shashank Pandya
- The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Puneet Pareek
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - V. Surya Rao
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | - C. Ramesh
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Manoj Rawal
- BPS Government Medical College for Women, Haryana, India
| | | | | | - Anand Shah
- The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - S.B. Singh
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Varinder Singh
- Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Deepak Sundriyal
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - T. Avinash
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Sopai Tawsik
- Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
| | - Lokesh Tiwari
- All India Institute of Medical Sciences, Patna, Bihar, India
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10
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Aristizabal P, Rivera-Gomez R, Chang A, Ornelas M, Ramirez M, Tamayo G, Martinez A, Ribeiro RC, Roberts W. Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models. JCO Glob Oncol 2023; 9:e2300123. [PMID: 37269343 PMCID: PMC10497272 DOI: 10.1200/go.23.00123] [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: 04/17/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/05/2023] Open
Abstract
PURPOSE Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence. METHODS In 2013, through a partnership between North-American and Mexican institutions, we used the WHO Framework for Action, a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators. RESULTS Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% (P = .023), 73% to 100% (P < .001), and 48% to 55% (P = .031), respectively. All sustainability indicators improved between 2013 and 2017. CONCLUSION Using the health systems strengthening WHO Framework for Action model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.
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Affiliation(s)
- Paula Aristizabal
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
- University of California San Diego Altman Clinical and Translational Research Institute, Dissemination and Implementation Science Center, La Jolla, CA
| | - Rebeca Rivera-Gomez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Andrew Chang
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Mario Ornelas
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Maribel Ramirez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Gabriela Tamayo
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Angelica Martinez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Raul C. Ribeiro
- Department of Oncology, Leukemia/Lymphoma Division, and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - William Roberts
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA
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11
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Srinivasan S, Ramanathan S, Prasad M. Wilms Tumor in India: A Systematic Review. South Asian J Cancer 2023; 12:206-212. [PMID: 37969674 PMCID: PMC10635777 DOI: 10.1055/s-0042-1758567] [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: 11/24/2022] Open
Abstract
Shyam SrinivasanBackground Cure rates of childhood malignancies are inferior in India compared with upper-middle-income countries. There is paucity of quality data addressing outcome of childhood Wilms tumor (WT) from India. This systematic review was conducted to assess the disease trends, treatment strategies, and outcome indicators in WT across India. Materials and Methods We conducted a systematic search of MEDLINE, Google Scholar, and SCOPUS database, and additionally screened International Society of Pediatric Oncology conference abstracts. Data concerning WT or nephroblastoma published from India were extracted. Results A total of 17 studies containing 1,170 patients were included in this review. Ninety-four percent of the studies were published after the year 2010. Advanced stage (III and IV) disease was seen in 46% of included patients. In seven studies, patients underwent a pretreatment biopsy before commencement of therapy. A hybrid approach consisting of "surgery first" in a selected subset and "neo-adjuvant chemotherapy" in all others was the most common treatment strategy adopted in half of the studies. The overall survival ranged between 48 and 89%. Key prognostic factors influencing survival across studies included increased tumor volume, metastatic disease, and unfavorable histology. Nonrelapse mortality (2.7-8.5%) was noted to be high. Conclusion Substantial proportion of children with WT from India present with advanced stages of the disease. Despite several limitations, the current systematic review showed a modest survival among Indian children with WT. Adopting strategies through collaboration to ensure early access to expert care along with involvement of social support team to improve compliance may further improve survival of WT in India.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subramaniam Ramanathan
- Department of Pediatric Oncology and BMT, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Maya Prasad
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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12
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Pascual Morales C, Vasquez Ponce L, Hernandez Briceño J, Leon Lopez E, Guevara Guevara J, Jimenez Vargas J, Diaz Coronado R, Flores JD, Lazon Ayala M. Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru. J Pediatr Hematol Oncol 2023; 45:e345-e349. [PMID: 36731067 DOI: 10.1097/mph.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/04/2022] [Indexed: 02/04/2023]
Abstract
Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients' data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.
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Affiliation(s)
| | - Liliana Vasquez Ponce
- "Medicina de Precision" Research Center, Universidad de San Martín de Porres, Facultad de Medicina
| | | | | | | | | | | | - Jose D Flores
- Neurosurgery Department, Guillermo Almenara Hospital
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13
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Cotache-Condor C, Kantety V, Grimm A, Williamson J, Landrum KR, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2023; 70:e30175. [PMID: 36579761 DOI: 10.1002/pbc.30175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
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Affiliation(s)
| | - Vinootna Kantety
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama, USA
| | | | - Kelsey R Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
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14
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Yafour N, Hamzy F, Elkababri M, Yakoub-Agha I, Bekadja MA. [Acute lymphoblastic leukemia in developing countries: Management from the transplant indication (allo/auto) until post-transplant follow-up. Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S30-S38. [PMID: 35562231 DOI: 10.1016/j.bulcan.2022.02.011] [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: 02/06/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
Management of acute lymphoblastic leukemia (ALL) patients in countries with limited resources depends on the means of prognostic stratification, available treatment and logistics. During the 12th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines for allogeneic hematopoietic cell transplantation (Allo-HCT) in this disease. Conventional poor prognostic factors can be used to determine the indication of allo-HCT in first remission. Patients lacking a HLA-matched related donor can be allografted with a haploidentical donor allo-HCT if available. Chemotherapy based conditioning regimen can be used if TBI is not available, because the probability to find a radiotherapy department with the capacity for total body irradiation is low. For patients with Philadelphia chromosome positive (Phi+) ALL, post-transplantation tyrosine kinase inhibitors as a systematic maintenance strategy is recommended. Autologous HCT is optional for Phi+ ALL patients with negative minimal residual disease, who not eligible for allo-HCT. Patients with refractory/relapsed disease have a poor prognosis which highlights the importance of acquiring in the future new therapies such as: blinatumumab, inotuzumab, and CAR-T cells.
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Affiliation(s)
- Nabil Yafour
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie.
| | - Faty Hamzy
- Hôpital Cheikh-Zaïd universitaire international, service d'hématologie et greffe, cité Al-Irfane-Hay Ryad avenue Allal-al-Fassi, 10000 Rabat, Maroc
| | - Maria Elkababri
- Hôpital d'enfants de Rabat, université Mohammed V de Rabat, service d'hématologie et oncologie pédiatrique, Rabat, Maroc
| | | | - Mohamed Amine Bekadja
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie
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15
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Deribe L, Addissie A, Girma E, Abraha A, Adam H, Berbyuk Lindström N. Stress and coping strategies among parents of children with cancer at Tikur Anbessa Specialized Hospital paediatric oncology unit, Ethiopia: a phenomenological study. BMJ Open 2023; 13:e065090. [PMID: 36609328 PMCID: PMC9827240 DOI: 10.1136/bmjopen-2022-065090] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study explores sources of stress, conditions that help reduce stress levels and coping strategies among parents of children with cancer receiving chemotherapy at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. DESIGN A qualitative phenomenological approach was used. SETTING Parents of children receiving chemotherapy at the TASH paediatric oncology unit. PARTICIPANTS Fifteen semistructured in-depth interviews were conducted with nine mothers and six fathers of children with cancer from November 2020 to January 2021. RESULTS Sources of stress related to child's health condition as the severity of the child's illness, fear of treatment side effects and loss of body parts were identified. Parents mentioned experiencing stress arising from limited access to health facilities, long waiting times, prolonged hospital stays, lack of chemotherapy drugs, and limited or inadequate information about their child's disease condition and treatment. Other sources of stress were insufficient social support, stigmatisation of cancer and financial problems. Conditions decreasing parents' stress included positive changes in the child's health, receiving cancer treatment and access to drugs. Receiving counselling from healthcare providers, getting social support and knowing someone who had a positive treatment outcome also helped reduce stress. Coping strategies used by parents were religious practices including prayer, crying, accepting the child's condition, denial and communication with health providers. CONCLUSION The main causes of stress identified by parents of children with cancer in Ethiopia were the severity of their child's illness, expectations of poor treatment outcomes, unavailability of cancer treatment services and lack of social/financial support. Measures that should be considered to reduce parents' stress include providing psycho-oncological care for parents and improving the counselling available to parents concerning the nature of the child's illness, its treatment, diagnostic procedures and treatment side effects. It may also be helpful to establish and strengthen family support groups and parent-to-parent communication, improve the availability of chemotherapy drugs and offer more education on coping strategies.
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Affiliation(s)
- Leul Deribe
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Department of Oncology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Haileyesus Adam
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Roach JT, Shlobin NA, Andrews JM, Baticulon RE, Campos DA, Moreira DC, Qaddoumi I, Boop FA. The Greatest Healthcare Disparity: Addressing Inequities in the Treatment of Childhood Central Nervous System Tumors in Low- and Middle-Income Countries. Adv Tech Stand Neurosurg 2023; 48:1-19. [PMID: 37770679 DOI: 10.1007/978-3-031-36785-4_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] [Indexed: 09/30/2023]
Abstract
The antithesis between childhood cancer survival rates in low- and middle-income countries (LMIC) and high-income countries (HIC) represents one of healthcare's most significant disparities. In HICs, the 5-year survival rate for children with cancer, including most brain tumors, exceeds 80%. Unfortunately, children in LMICs experience far worse outcomes with 5-year survival rates as low as 20%. To address inequities in the treatment of childhood cancer and disease burden globally, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer. Within this initiative, pediatric low-grade glioma (LGG) represents a unique opportunity for the neurosurgical community to directly contribute to a paradigm shift in the survival outcomes of children in LMICs, as many of these tumors can be managed with surgical resection alone. In this chapter, we discuss the burden of pediatric LGG and outline actions the neurosurgical community might consider to improve survival for children with LGG in LMICs.
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Affiliation(s)
- Jordan T Roach
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jared M Andrews
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Danny A Campos
- Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Daniel C Moreira
- 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
| | - Ibrahim Qaddoumi
- 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
| | - Frederick A Boop
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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17
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Lv W, Chen T, Wang S, Li C, Zhang B, Wang L, Xv F, Cao F, Wang J, Chen L, Liao C, Li N, Liu H. Feasibility of high-throughput drug sensitivity screening (HDS)-guided treatment for children with refractory or relapsed acute myeloid leukemia. Front Pediatr 2023; 11:1117988. [PMID: 36873635 PMCID: PMC9982438 DOI: 10.3389/fped.2023.1117988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Relapsed/refractory (rel/ref) acute myeloid leukemia (AML) has a very high mortality rate. At present, hematopoietic stem cell transplantation (HSCT) is the most effective treatment for rel/ref AML. The remission of the primary disease before HSCT is crucial for the transplantation to be effective. Therefore, it is critical to choose a suitable type of chemotherapy before HSCT. Here, we recorded the outcomes of high-throughput drug sensitivity screening (HDS) in children with rel/ref AML. Thirty-seven pediatric rel/ref AML patients who received HDS from September 2017 until July 2021 were analyzed retrospectively. Most of the patients (24 patients, 64.9%) had adverse cytogenetics. Two patients had rel/ref AML with central nervous system leukemia. The complete remission (CR) rate was 67.6%. Eight patients developed IV grade bone marrow suppression. Twenty-three patients (62.2%) underwent HSCT. The 3-year overall survival (OS) and EFS rates were 45.9% and 43.2%, respectively. Infection in the myelosuppression stage was the main cause of death. The outcome of HDS was superior to the commonly reported rates. These results suggest that HDS may be a novel treatment option for pediatric patients with rel/ref AML, and it is a promising transitional regimen prior to HSCT.
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Affiliation(s)
- Wenxiu Lv
- Department of Hematology and Oncology, Anhui Provincial Children's Hospital (Anhui Hospital, Pediatric Hospital of Fudan University), Hefei, Anhui, China.,Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Tianping Chen
- Department of Hematology and Oncology, Anhui Provincial Children's Hospital (Anhui Hospital, Pediatric Hospital of Fudan University), Hefei, Anhui, China
| | - Shen Wang
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chun Li
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Bo Zhang
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Liang Wang
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Fang Xv
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Fang Cao
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jing Wang
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Chen
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenglin Liao
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Na Li
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Hongjun Liu
- Department of Hematology and Oncology, Anhui Provincial Children's Hospital (Anhui Hospital, Pediatric Hospital of Fudan University), Hefei, Anhui, China
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18
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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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19
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Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic. BMJ Glob Health 2022; 7:bmjgh-2022-008797. [PMID: 36261229 PMCID: PMC9581782 DOI: 10.1136/bmjgh-2022-008797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/13/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.
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20
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Mechita NB, Cherkaoui S, Abousselham L, Benmiloud S, Kili A, Kababri ME, Maani K, Houdzi JE, Benajiba N, Madani A, Bennani M, Belakhel L, Bouffet E, Patte C, Harif M, Youbi M, Hessissen L. Implementing the WHO Global Initiative for Childhood Cancer in Morocco: Survival study for the six indexed childhood cancers. Pediatr Blood Cancer 2022; 69:e29788. [PMID: 35796382 DOI: 10.1002/pbc.29788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2018, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer (GICC). The goal is to achieve a global survival rate of at least 60% for all children with cancer by 2030. Morocco was designated as a pilot country for this initiative. PROCEDURE This retrospective study included a cohort of children aged 0-15 years, with one of the six indexed cancers (acute lymphoblastic leukemia [ALL], Burkitt lymphoma [BL], Hodgkin lymphoma, retinoblastoma [RB], Wilms tumor or nephroblastoma, low-grade glioma), diagnosed between January 1, 2017 and December 31, 2019 at the six Moroccan Pediatric Hematology and Oncology units. Patients were followed-up until August 31, 2020. The Kaplan-Meier method was used to estimate survival rates, the log-rank test for comparing survival curves, and the Cox model for identifying prognostic factors. RESULTS Data on 878 patients were included in the study. The most frequently reported cancer type was ALL (n = 383, 43.6%), followed by Wilms tumor (n = 139, 15.8%) and BL (n = 133, 15%). Most patients were less than 5 years of age (n = 446, 50.9%) and the male/female ratio was 1.46. The 1, 2, and 3-year overall survival rates were 80.1%, 73.6%, and 68.2%, respectively. In a multivariable Cox regression model, care center, cancer type, age group, and distance to the care center were statistically significantly associated to survival. Patients aged 10 years and older and patients living more than 100 km from the care center were more likely to die (respectively, HR = 1.39, p = .045 and HR = 1.44, p = .010). CONCLUSION The reported results represent the baseline for measuring the impact of GICC implementation in Morocco.
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Affiliation(s)
| | - Siham Cherkaoui
- Pediatric Hematology and Oncology Unit, 2O August Hospital Casablanca, Moroccan Society of Pediatric Hematology and Oncology, Casablanca, Morocco
| | | | - Sarra Benmiloud
- Pediatric Hematology and Oncology Unit of Fès, Moroccan Society of Pediatric Hematology and Oncology, Fès, Morocco
| | - Amina Kili
- Pediatric Hematology and Oncology Department of Rabat, Moroccan Society of Pediatric Hematology and Oncology, Rabat, Morocco
| | - Maria El Kababri
- Pediatric Hematology and Oncology Department of Rabat, Moroccan Society of Pediatric Hematology and Oncology, Rabat, Morocco
| | - Khadija Maani
- Pediatric Hematology and Oncology Unit at Abderrahim El Harouchi Hospital Casablanca, Moroccan Society of Pediatric Hematology and Oncology, Casablanca, Morocco
| | - Jamila El Houdzi
- Pediatric Hematology and Oncology Department of Marrakech, Moroccan Society of Pediatric Hematology and Oncology, Marrakech, Morocco
| | - Noufissa Benajiba
- Pediatric Hematology and Oncology Department of Oujda, Moroccan Society of Pediatric Hematology and Oncology, Oujda, Morocco
| | - Abdellah Madani
- Pediatric Hematology and Oncology Unit, 2O August Hospital Casablanca, Moroccan Society of Pediatric Hematology and Oncology, Casablanca, Morocco
| | - Maria Bennani
- Lalla Salma Foundation - Cancer Prevention and Treatment, Rabat, Morocco
| | - Latefa Belakhel
- Directorate of Epidemiology and Disease Control, Rabat, Morocco
| | - Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Patte
- Francophone African Group of Pediatric Oncology, Gustave Roussy Institut, Villejuif, France
| | - Mhamed Harif
- University Hospital Center of Tangier, Tangier, Morocco
| | - Mohammed Youbi
- Directorate of Epidemiology and Disease Control, Rabat, Morocco
| | - Laila Hessissen
- Pediatric Hematology and Oncology Department of Rabat, Moroccan Society of Pediatric Hematology and Oncology, Rabat, Morocco
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21
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Morgan A, Watt M, Zullig L, Sued H, Schroeder K. Pediatric cancer outcomes after the implementation of a residential hostel in Tanzania. Pediatr Blood Cancer 2022; 69:e29758. [PMID: 35593643 DOI: 10.1002/pbc.29758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/19/2022] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND A large survival disparity exists for pediatric cancer patients in low- and middle-income countries compared with high-income countries. A variety of factors contribute to this gap, including late-stage disease at presentation, high rates of abandonment of care, and lack of supportive care infrastructure. A residential hostel was established in Mwanza, Tanzania, to reduce barriers to accessing and maintaining care among patients being treated for childhood cancer at a regional referral hospital. This study examines the effect of the hostel on one-year survival and treatment abandonment for children diagnosed with cancer. METHODS Medical records were retrospectively reviewed for all patients presenting from May 2017 to April 2018, following the establishment of a pediatric cancer hostel at the referral hospital. Active follow-up was used to confirm survival data. RESULTS There were 149 patients who presented to the referral hospital during the study period with 130 eligible for evaluation. A total of 34% (n = 44) used the hostel services and 66% did not use the hostel (n = 86). Patients who used the hostel did not significantly differ by age, sex, or diagnosis compared with patients who did not use the hostel. Patients who used the hostel had lower treatment abandonment (27% vs 37%) and higher one-year overall survival (47% vs 37%) compared with patients who did not use the hostel. CONCLUSION Our findings suggest key supportive programs such as a family hostel may be beneficial for patients with childhood cancer and can improve pediatric cancer treatment outcomes in LMICs.
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Affiliation(s)
- Austin Morgan
- Duke University, Durham, North Carolina, Oregon Health and Science University School of Medicine, Portland, Oregon
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22
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Ni X, Li Z, Li X, Zhang X, Bai G, Liu Y, Zheng R, Zhang Y, Xu X, Liu Y, Jia C, Wang H, Ma X, Zheng H, Su Y, Ge M, Zeng Q, Wang S, Zhao J, Zeng Y, Feng G, Xi Y, Deng Z, Guo Y, Yang Z, Zhang J. Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study. Lancet 2022; 400:1020-1032. [PMID: 36154677 DOI: 10.1016/s0140-6736(22)01541-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the substantial burden caused by childhood cancer globally, childhood cancer incidence obtained in a nationwide childhood cancer registry and the accessibility of relevant health services are still unknown in China. We comprehensively assessed the most up-to-date cancer incidence in Chinese children and adolescents, nationally, regionally, and in specific population subgroups, and also examined the association between cancer incidence and socioeconomic inequality in access to health services. METHODS In this national cross-sectional study, we used data from the National Center for Pediatric Cancer Surveillance, the nationwide Hospital Quality Monitoring System, and public databases to cover 31 provinces, autonomous regions, and municipalities in mainland China. We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China through stratified proportional estimation. We classified regions by socioeconomic status using the human development index (HDI). Incidence rates of 12 main groups, 47 subgroups, and 81 subtypes of cancer were reported and compared by sex, age, and socioeconomic status, according to the third edition of the International Classification of Childhood Cancer. We also quantified the geographical and population density of paediatric oncologists, pathology workforce, diagnoses and treatment institutions of paediatric cancer, and paediatric beds. We used the Gini coefficient to assess equality in access to these four health service indicators. We also calculated the proportions of cross-regional patients among new cases in our surveillance system. FINDINGS We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China from Jan 1, 2018, to Dec 31, 2020. An estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, with world standard age-standardised incidence rates of 122·86 (95% CI 121·70-124·02) per million for children and 137·64 (136·08-139·20) per million for adolescents. Boys had a higher incidence rate of childhood cancer (133·18 for boys vs 111·21 for girls per million) but a lower incidence of adolescent cancer (133·92 for boys vs 141·79 for girls per million) than girls. Leukaemias (42·33 per million) were the most common cancer group in children, whereas malignant epithelial tumours and melanomas (30·39 per million) surpassed leukaemias (30·08 per million) in adolescents as the cancer with the highest incidence. The overall incidence rates ranged from 101·60 (100·67-102·51) per million in very low HDI regions to 138·21 (137·14-139·29) per million in high HDI regions, indicating a significant positive association between the incidence of childhood and adolescent cancer and regional socioeconomic status (p<0·0001). The incidence in girls showed larger variation (48·45% from the lowest to the highest) than boys (36·71% from lowest to highest) in different socioeconomic regions. The population and geographical densities of most health services also showed a significant positive correlation with HDI levels. In particular, the geographical density distribution (Gini coefficients of 0·32-0·47) had higher inequalities than population density distribution (Gini coefficients of 0·05-0·19). The overall proportion of cross-regional patients of childhood and adolescent cancer was 22·16%, and the highest proportion occurred in retinoblastoma (56·54%) and in low HDI regions (35·14%). INTERPRETATION Our study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer. FUNDING National Major Science and Technology Projects of China, National Natural Science Foundation of China, Chinese Academy of Engineering Consulting Research Project, Wu Jieping Medical Foundation, Beijing Municipal Administration of Hospitals Incubating Program.
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Affiliation(s)
- Xin Ni
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| | - Zhe Li
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xinping Li
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao Zhang
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoliang Bai
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingying Liu
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Rongshou Zheng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yawei Zhang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Xu
- Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuanhu Liu
- Department of Otolaryngology Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenguang Jia
- Stem Cell Transplantation Department, Medical Administration Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huanmin Wang
- Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Medical Oncology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huyong Zheng
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Su
- Medical Oncology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junyang Zhao
- Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yueping Zeng
- Department of Medical Record Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Xi
- Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhuo Deng
- Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhuoyu Yang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinzhe Zhang
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Fowokan A, Afungchwi GM, Renner L, Freccero P, Gupta S, Denburg A. Evaluation of a Health Care Worker Training Intervention to Improve the Early Diagnosis and Referral of Childhood Cancers in Ghana: A Qualitative Descriptive Study. JCO Glob Oncol 2022; 8:e2200151. [PMID: 36103639 PMCID: PMC9812462 DOI: 10.1200/go.22.00151] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS We identified six themes-affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement-that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.
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Affiliation(s)
- Adeleke Fowokan
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lorna Renner
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - Sumit Gupta
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Avram Denburg
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada,Avram Denburg, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8 Canada; e-mail:
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24
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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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25
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Dai Q, Liu R, Wang Y, Ye L, Peng L, Shi R, Guo S, He J, Yang H, Zhang G, Jiang Y. Longer Time Intervals From Symptom Onset to Diagnosis Affect the Overall Survival in Children With Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2022; 44:285-292. [PMID: 34699460 DOI: 10.1097/mph.0000000000002344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Early diagnosis and timely treatment are essential for effective cancer control and have been widely analyzed in childhood cancer. However, few studies have described the time to diagnosis and treatment in children with ALL. This study investigated delays in diagnosis and treatment initiation and their impact on survival. METHODS This retrospective cohort study included 419 patients 0 to 14 years old at a tertiary hospital between 2011 and 2015. The optimal cutoff values for delays were determined by X-tile software. The Kaplan-Meier method and Cox regression models were used to evaluate the impact of delays on survival. RESULTS The median diagnosis, treatment, and total delays were 21 (interquartile range [IQR]: 11-35), 4 (IQR: 2-7), and 26 (IQR: 16-43) days, respectively. The results of multivariate analyses showed that diagnosis delay, risk stratification, and minimal residual disease level were independent predictors for treatment outcome in childhood ALL. CONCLUSIONS These findings suggested that a longer time to diagnosis negatively affected the clinical outcome of childhood ALL. Reducing the time to diagnosis could help to improve survival in these patients.
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Affiliation(s)
- Qingkai Dai
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yuefang Wang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Lei Ye
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Luyun Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Siqi Guo
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Jiajing He
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Hao Yang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ge Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yongmei Jiang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Garniasih D, Susanah S, Sribudiani Y, Hilmanto D. The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia: A systematic review and meta-analysis. PLoS One 2022; 17:e0269706. [PMID: 35696384 PMCID: PMC9191700 DOI: 10.1371/journal.pone.0269706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of childhood ALL in Indonesia is still largely unknown. The widely mentioned statistics from other countries turn out to be only estimated figures. Other data do not specify the types of leukemia and are not specifically focused on children. Therefore, this study aims to pool incidence and mortality statistics from available studies in Indonesia. Methods We searched five different academic databases, including Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar. Three Indonesian databases, such as the Indonesian Scientific Journal Database (ISJD), Neliti, and Indonesia One Search, were also utilized. Incidence was expressed as per 100,000 children. We used the Newcastle-Ottawa scale (NOS) to assess the quality of cohort studies. The inclusion criteria are cohort studies published in the languages of English or Indonesian. For this analysis, we define children as 0–18 years old. Findings The incidence rate for childhood ALL was found to be 4.32 per 100,000 children (95% CI 2.65–5.99) with a prediction interval of 1.98 to 9.42 per 100,000 children. The incidence rate is higher in males, with 2.45 per 100,000 children (95% CI 1.98–2.91) and a prediction interval of 1.90 to 3.16 per 100,000 children. As for females, the incidence rate is 2.05 per 100,000 children (95% CI 1.52–2.77) with a prediction interval of 1.52 to 2.77 per 100,000 children. The mortality of childhood ALL ranges from 0.44 to 5.3 deaths per 100,000 children, while the CFR is 3.58% with varying true effect sizes of 2.84% to 4.52%. Interpretation With 79.5 million children living in Indonesia in 2018, this means that there were roughly 3,434 new cases of childhood ALL. An organized effort between multiple sectors is needed to improve the registries of childhood ALL in Indonesia.
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Affiliation(s)
- Dina Garniasih
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- * E-mail:
| | - Susi Susanah
- Department of Pediatrics, Universitas Padjadjaran, Bandung, Indonesia
- Research Center of Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Yunia Sribudiani
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center of Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dany Hilmanto
- Department of Pediatrics, Universitas Padjadjaran, Bandung, Indonesia
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Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study. BMJ Open 2022; 12:e054690. [PMID: 35410925 PMCID: PMC9021459 DOI: 10.1136/bmjopen-2021-054690] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN A multicentre, international, collaborative cohort study. SETTING 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE All-cause mortality at 30 days and 90 days. RESULTS 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.
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Hopp AM, Tetzlaff JE, Kopidlansky K, Leventaki V, Parsons LN, Bone K, Drendel HM, Sreynich K, Lyvannak S, Heng S, Chanpheaktra N, Putchhat H, Khauv P, Camitta BM, Jarzembowski JA. It Takes a Village. Am J Clin Pathol 2022; 158:81-95. [PMID: 35050350 DOI: 10.1093/ajcp/aqab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Partnerships between low- to middle-income countries (LMICs) and high-income countries (HICs) is one strategy to mitigate observed health disparities. Cambodia's Angkor Hospital for Children (AHC), an LMIC institution, faces shortages in health care resources, including pathology services. A partnership was created with Children's Wisconsin (CW), an HIC hospital, including provision of pathology services. We describe our established pathology workflow, examine cases seen in AHC patients, and evaluate the impact of CW's interpretations. METHODS AHC provides clinical history and impression and ships samples to CW, which processes the samples, and pathologists provide interpretations, sending reports electronically to AHC. For analysis, final diagnoses were considered "concordant," "refined," or "discordant" based on agreement with the clinical impression. Cases were also classified as "did not change management" or "changed management" based on how CW interpretation affected clinical management. RESULTS We included 347 specimens (177 malignant, 146 benign, 24 insufficient for diagnosis). Of these cases, 31% were discordant and 44% of cases with clinical follow-up had a change in management with CW interpretation. CONCLUSIONS Inclusion of pathology services in LMIC-HIC partnerships is crucial for resolving health disparities between the institutions involved. The described partnership and established pathology workflow can be adapted to the needs and resources of many institutions.
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Affiliation(s)
- Amanda M Hopp
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie E Tetzlaff
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kyle Kopidlansky
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
| | - Vasiliki Leventaki
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lauren N Parsons
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen Bone
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Holli M Drendel
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Sam Lyvannak
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sing Heng
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | | | - Phara Khauv
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Bruce M Camitta
- Department of Hematology, Oncology, and Blood and Marrow Transplant, Children’s Wisconsin, Milwaukee, WI, USA
| | - Jason A Jarzembowski
- Department of Pathology, Children’s Wisconsin, Milwaukee, WI, USA
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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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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Olbara G, van der Wijk T, Njuguna F, Langat S, Mwangi H, Skiles J, Vik TA, Kaspers GJL, Mostert S. Childhood acute lymphoblastic leukemia treatment in an academic hospital in Kenya: Treatment outcomes and health-care providers' perspectives. Pediatr Blood Cancer 2021; 68:e29366. [PMID: 34569156 DOI: 10.1002/pbc.29366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early deaths and treatment nonadherence are major reasons for low childhood acute lymphoblastic leukemia (ALL) survival in low- and middle-income countries. This study assessed treatment outcomes of children presenting with ALL and evaluated perspectives of health-care providers (HCP) on ALL treatment at a Kenyan academic hospital. METHODS This was a combined retrospective medical records and cross-sectional questionnaire study. Treatment outcomes of 136 children diagnosed with ALL between 2010 and 2016 were collected. Questionnaires were completed by 245 HCP (response rate, 86%) between September and October 2016. RESULTS Childhood ALL treatment outcomes were death (30%), progressive or relapsed disease (26%), abandonment (24%), and event-free survival (20%). Of all deaths, 80% were early deaths (prior or during induction), whereas 20% occurred in remission. Probability of event-free survival at three years was 18%. Only 57% of HCP believed childhood ALL can be cured, with more doctors (96%) than other HCP (45%) believing in curability of ALL (P < 0.001). The majority of HCP (96%) thought that experienced doctors should put more time and effort into making parents understand the diagnosis and necessity to complete treatment. According to HCP, reasons for protocol nonadherence included parental financial difficulties (94%) and use of alternative treatment (79%). CONCLUSIONS Event-free survival for ALL in Kenya is low. The primary reason for treatment failure is early death from treatment-related complications. More efforts should be directed toward improving supportive care strategies. In the opinion of HCPs, improved communication with parents and supervision of junior staff will improve ALL treatment outcomes.
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Affiliation(s)
- Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Thyra van der Wijk
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Henry Mwangi
- Department of Health Information Management, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terrry A Vik
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya.,Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gertjan J L Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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31
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Chagaluka G, Afungchwi GM, Landman L, Njuguna F, Hesseling P, Tchintseme F, Sung L, Paintsil V, Molyneux E, Chitsike I, Israels T. Treatment abandonment: A report from the collaborative African network for childhood cancer care and research-CANCaRe Africa. Pediatr Blood Cancer 2021; 68:e29367. [PMID: 34549506 DOI: 10.1002/pbc.29367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low- and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. METHODS A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). CONCLUSIONS Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.
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Affiliation(s)
- George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Glenn Mbah Afungchwi
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lisa Landman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Tchintseme
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - Trijn Israels
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Geel JA, Challinor J, Ranasinghe N, Myezo KH, Eyal KC, Aderounmu W, Davidson A, Pritchard-Jones K, Howard SC, Bouffet E, Hessissen L. Pediatric cancer care in Africa: SIOP Global Mapping Program report on economic and population indicators. Pediatr Blood Cancer 2021; 68:e29345. [PMID: 34519435 DOI: 10.1002/pbc.29345] [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: 02/14/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Inalignment with the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC), the International Society of Pediatric Oncology initiated a program to map global pediatric oncology services. As survival rates in Africa are low and data are scant, this continent was mapped first to identify areas with greatest need. METHODS Beginning November 2018, an electronic survey was sent to all known stakeholders, followed by email communications and internet searches to verify data. Availability of pediatric oncologists, chemotherapy, surgical expertise, and radiotherapy was correlated with geographic region, World Bank income status, Universal Health Coverage, population < 15 and < 24 years, percentage of gross domestic product spent on healthcare, and Human Development Index (HDI). RESULTS Responses were received from 48/54 African countries. All three treatment modalities were reportedly available in 9/48 countries, whereas seven countries reported no pediatric oncology services. Negative correlations were detected between provision of all three services and geographic region (P = 0.01), younger median population age (P = 0.002), low-income country status (P = 0.045), and lower HDI (P < 0.001). CONCLUSION This study provides a comprehensive overview of pediatric oncology care in Africa, emphasizing marked disparities between countries: some have highly specialized services, whereas others have no services. A long-term strategy to eliminate disparities in African pediatric cancer care should be aligned with the WHO GICC aims and facilitated by SIOP Africa. MEETING ABSTRACTS SIOP maps pediatric oncology services in Africa to address inequalities in childhood cancer services. Geel J, Ranasinghe N, Davidson A, Challinor J, Howard S, Wollaert S, Myezo K, Renner L, Hessissen L, Bouffet E. 51st Annual Congress of the International Society of Paediatric Oncology (SIOP), Lyon, France, October 2019. Pediatric Blood and Cancer Vol 66 S219-S219. Pediatric cancer care in Africa: SIOP Global Mapping Program report on economic and population indicators.
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Affiliation(s)
- Jennifer Ann Geel
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Neil Ranasinghe
- SIOP PODC Education and Training Working Group, Refinitiv, UK
| | - Khumo Hope Myezo
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Wuraole Aderounmu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Davidson
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Scott C Howard
- Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, USA.,Resonance, Arlington, USA
| | - Eric Bouffet
- Garron Chair in Childhood Cancer Research, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Laila Hessissen
- Paediatric Hematology and Oncology Unit of Rabat, Mohamed V University, Rabat, Morocco
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Ghalibafian M, Masoudifar M, Mohammadi E, Girinsky T, Oberlin O, Bouffet E. Establishing a pediatric radiation oncology department in a low- and middle-income country: Major challenge in implementing the Global Initiative for Childhood Cancer. Pediatr Blood Cancer 2021; 68:e29233. [PMID: 34357689 DOI: 10.1002/pbc.29233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Mithra Ghalibafian
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Maryam Masoudifar
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Ehsan Mohammadi
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Odile Oberlin
- Department of Pediatrics, Gustave Roussy, Villejuif, France
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Malvezzi M, Santucci C, Alicandro G, Carioli G, Boffetta P, Ribeiro KB, Levi F, La Vecchia C, Negri E, Bertuccio P. Childhood cancer mortality trends in the Americas and Australasia: An update to 2017. Cancer 2021; 127:3445-3456. [PMID: 34043810 PMCID: PMC8453533 DOI: 10.1002/cncr.33642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/19/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends. METHODS Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries. RESULTS Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia. CONCLUSIONS Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide. LAY SUMMARY Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.
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Affiliation(s)
- Matteo Malvezzi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Claudia Santucci
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Gianfranco Alicandro
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Greta Carioli
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paolo Boffetta
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew York
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Karina Braga Ribeiro
- Department of Collective HealthFaculdade de Ciências Médicas da Santa Casa de São PauloSão PauloBrazil
- Department of Pediatric OncologyHospital Santa Marcelina/TUCCASão PauloBrazil
| | - Fabio Levi
- Department of Epidemiology and Health Services ResearchCentre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eva Negri
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paola Bertuccio
- Department of Biomedical and Clinical Sciences L. SaccoUniversità degli Studi di MilanoMilanItaly
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Israels T, Afungchwi GM, Chagaluka G, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Njuguna F, Sung L, Molyneux E. Early death and treatment-related mortality: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29230. [PMID: 34245228 DOI: 10.1002/pbc.29230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment-related and disease-related causes. To prevent these deaths, it is important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment. METHODS We conducted a multicentre prospective, observational cohort study in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were abstracted in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment-related cause. Treatment-related mortality of all patients in the first 3 months of treatment was 13% (33/252). CONCLUSION Fifteen percent of patients had an early death during treatment and 13% had a treatment-related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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Israels T, Afungchwi GM, Klootwijk L, Njuguna F, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Chagaluka G, Sung L, Molyneux E. Fever and neutropenia outcomes and areas for intervention: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29224. [PMID: 34245212 DOI: 10.1002/pbc.29224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Death during paediatric cancer treatment is common in sub-Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention. METHODS A multicentre prospective, observational cohort study was conducted in sub-Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were abstracted in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented. RESULTS A total of 252 patients were included (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109 /L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes. CONCLUSIONS Although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment-related mortality.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Larissa Klootwijk
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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Chitsike I, Paintsil V, Sung L, Njuguna F, Mavinkurve-Groothuis A, Kouya F, Hesseling P, Kaspers G, Afungchwi GM, Ilbawi A, Renner L, Pritchard-Jones K, Hessissen L, Molyneux E, Chagaluka G, Israels T. Working Together to Build a Better Future for Children With Cancer in Africa. JCO Glob Oncol 2021; 6:1076-1078. [PMID: 32673078 PMCID: PMC7392779 DOI: 10.1200/go.20.00170] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Inam Chitsike
- Department of Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Vivian Paintsil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Francine Kouya
- Department of Pediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Peter Hesseling
- Department of Pediatrics and Child Health, Stellenbosch University, South Africa
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands
| | - Glenn M Afungchwi
- Department of Pediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Andre Ilbawi
- Global Initiative for Childhood Cancer, WHO, Geneva, Switzerland
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Center, Mohamed V University, Rabat, Morocco
| | | | | | - Trijn Israels
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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van Heerden J, Zaghloul M, Neven A, de Rojas T, Geel J, Patte C, Balagadde-Kambugu J, Hesseling P, Tchintseme F, Bouffet E, Hessissen L. Pediatric Oncology Clinical Trials and Collaborative Research in Africa: Current Landscape and Future Perspectives. JCO Glob Oncol 2021; 6:1264-1275. [PMID: 32762563 PMCID: PMC7456323 DOI: 10.1200/go.20.00159] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Adequate clinical services have yet to be established in the majority of African countries, where childhood cancer survival rates vary from 8.1% to 30.3%. The aim of this review is to describe the landscape of pediatric oncology trials in Africa, identify challenges, and offer future opportunities for research collaborations. METHODS The study includes data from the International Pediatric Oncology Society (SIOP) global mapping survey, meta-research identifying trials in Africa in ClinicalTrials.gov, and a literature overview of publications on the subject of pediatric oncology clinical research supported by expert opinions on the current situation and challenges. RESULTS The SIOP global mapping survey received responses from 47 of 54 African countries, of which 23 have active clinical research programs. A preliminary search of ClinicalTrials.gov showed that only 105 (12.1%) of 868 African oncology studies included children and adolescents. Of these, 53 (50.5%) were interventional trials according to the registry’s classification. The small number of African trials for children and adolescents included palliative care and leukemia trials. In African oncology journals and international pediatric oncology journals, < 1% of the pediatric oncology publications come from Africa. Services and research were strengthened by international collaboration. National studies focused on clinical needs, local challenges, or interventional priorities. Both the literature review and the expert opinions highlight the need to expand clinical research in Africa, despite ongoing regional instability and lack of resources. CONCLUSION While a low number of pediatric clinical treatment trials are open to African children and adolescents, clinical research of high quality is being done in Africa. Several initiatives are stimulating the development of the research capacity across the continent, which should increase the publication output.
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Affiliation(s)
- Jaques van Heerden
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.,Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Mohamed Zaghloul
- Radiation Oncology Department, National Cancer Institute, Cairo University and Children's Cancer Hospital, Cairo, Egypt
| | - Anouk Neven
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda.,Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Teresa de Rojas
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda.,Pediatric OncoGenomics Unit, Pediatric Oncology-Hematology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - 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
| | - Catherine Patte
- Franco-African Pediatric Oncology Group and Gustave Roussy Institute, Villejuif, France
| | | | - Peter Hesseling
- Department of Pediatrics and Child Health, Tygerberg Childrens' Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Eric Bouffet
- Pediatric Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Laila Hessissen
- Pediatric Haematology and Oncology Center, University Mohamed V. Rabat, Rabat, Morocco
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Peter N, Bandyopadhyay S, Lakhoo K. Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study. BMJ Open 2021; 11:e045679. [PMID: 34083337 PMCID: PMC8182746 DOI: 10.1136/bmjopen-2020-045679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children's cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children's Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes. METHODS AND ANALYSIS This is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2 analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors. ETHICS AND DISSEMINATION At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Noel Peter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study. Cancer Nurs 2021; 43:E342-E348. [PMID: 31107702 DOI: 10.1097/ncc.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment. OBJECTIVE To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania. METHOD Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis. RESULTS Guardians experienced several issues during the initial stages of their child's cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope. CONCLUSION Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment. IMPLICATIONS FOR PRACTICE Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders' support needs.
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41
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Adade CA, Diop BB, Attjioui H, Cheikh A, Mefetah H, Bouatia M. Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding. J Oncol Pharm Pract 2021; 28:605-612. [PMID: 33847197 DOI: 10.1177/10781552211008527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. OBJECTIVE The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. MATERIALS AND METHODS This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. RESULTS In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. CONCLUSION The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.
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Affiliation(s)
- Casimir Adade Adade
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Boubacar Bf Diop
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Houda Attjioui
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Amine Cheikh
- Department of Pharmacy, Faculty of Pharmacy, Abulcasis University, Rabat, Morocco
| | - Hafid Mefetah
- Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Mustapha Bouatia
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
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Schüz J, Roman E. Childhood cancer: A global perspective. Cancer Epidemiol 2021; 71:101878. [PMID: 33358343 DOI: 10.1016/j.canep.2020.101878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
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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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Edan C, Yao AJJ, Hessissen L, Moreira C, Viallard ML, Poulain P, Calmanti S, Thinlot C, Aubier F, Douçot MS, Gagnepain-Lacheteau A, Patte C. Integrating a palliative approach into the healthcare provided by the French-African Pediatric Oncology Group's pilot units. Insights from a 3-year training program. Arch Pediatr 2021; 28:166-172. [PMID: 33446430 DOI: 10.1016/j.arcped.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/20/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Working alongside local stakeholders, members of the French-African Pediatric Oncology Group developed a 3-year program to train pediatric oncology teams from 15 French-speaking countries in Africa in using analgesics and providing palliative care. This program was rolled out in three phases: initial training, in situ assessment, and advanced training in selected topics. To access this program, multidisciplinary teams had to come up with a project to improve their existing palliative care and pain management practices, and commit themselves to implementing it. All the teams invited agreed to take part in the program, which explicitly broached a subject that is often avoided in oncology teaching. The first phase was rolled out in 2017, with 65 trainees from 19 units attending one of three sessions held in Dakar, Senegal, Abidjan, Côte d'Ivoire, and Rabat, Morocco. The subsequent assessment revealed that only half the teams had started to implement their projects. The advanced training phase was therefore adjusted accordingly. A collective training session held in Marseille was attended by 15 trainees from seven teams whose projects were already underway, while in situ mentoring was provided for six other teams, through French-African twinnings in four cases. The length and openness of the program meant that we were able to identify and share the units' diverse realities, and fine-tune their projects accordingly, as well as plan ways of continuing the training both locally and collectively.
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Affiliation(s)
- C Edan
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - A J J Yao
- Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - L Hessissen
- Pediatric Oncology Department, Children's Hospital, Rabat, Morocco
| | - C Moreira
- Pediatric Oncology Unit, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M L Viallard
- Department of Perinatal Pain and Palliative Medicine, Necker University Hospital for Sick Children, Paris, France
| | - P Poulain
- Les Ormeaux palliative care unit, Tarbes, France
| | - S Calmanti
- La Brise regional pediatric palliative care team, Brittany, France
| | - C Thinlot
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - F Aubier
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - M S Douçot
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | | | - C Patte
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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Piñeros M, Mery L, Soerjomataram I, Bray F, Steliarova-Foucher E. Scaling Up the Surveillance of Childhood Cancer: A Global Roadmap. J Natl Cancer Inst 2021; 113:9-15. [PMID: 32433739 PMCID: PMC7781445 DOI: 10.1093/jnci/djaa069] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
The World Health Organization recently launched the Global Initiative for Childhood Cancer aiming to substantially increase survival among children with cancer by 2030. The ultimate goal concerns particularly less developed countries where survival estimates are considerably lower than in high-income countries where children with cancer attain approximately 80% survival. Given the vast gap in high-quality data availability between more and less developed countries, measuring the success of the Global Initiative for Childhood Cancer will also require substantial support to childhood cancer registries to enable them to provide survival data at the population level. Based on our experience acquired at the International Agency for Research on Cancer in global cancer surveillance, we hereby review crucial aspects to consider in the development of childhood cancer registration and present our vision on how the Global Initiative for Cancer Registry Development can accelerate the measurement of the outcome of children with cancer.
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Affiliation(s)
- Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Les Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Doubova SV, Knaul FM, Borja-Aburto VH, Garcia-Saíso S, Zapata-Tarres M, Gonzalez-Leon M, Sarabia-Gonzalez O, Arreola-Ornelas H, Pérez-Cuevas R. Access to paediatric cancer care treatment in Mexico: responding to health system challenges and opportunities. Health Policy Plan 2020; 35:291-301. [PMID: 31872242 DOI: 10.1093/heapol/czz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
In Mexico, paediatric cancer is the leading cause of death for children aged 0-18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008-18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Health Research Coordination, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, Mexico City 06720, Mexico
| | - Felicia Marie Knaul
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.,Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL 33146, USA.,Tómatelo a Pecho A.C., Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, Ciudad de México 14610, México.,Mexican Health Foundation (FUNSALUD), Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, Ciudad de México 14610, México
| | - Víctor Hugo Borja-Aburto
- Directorate of Medical Benefits, Mexican Institute of Social Security, Av. Paseo de la Reforma No. 476, Juárez, Cuauhtémoc, Ciudad de México 06600, Mexico
| | - Sebastian Garcia-Saíso
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad Universitaria, Edificio CIPPS-Sótano y piso 2, Cto. Centro Cultural S/N, C.U., Ciudad de México 04510, México
| | - Marta Zapata-Tarres
- Department of Oncology, National Institute of Pediatrics, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México 04530, México
| | - Margot Gonzalez-Leon
- Epidemiology Surveillance Coordination, Mexican Institute of Social Security, Mier y Pesado 120, Col. del Valle Nte, Benito Juárez, Ciudad de México 03100, México
| | - Odet Sarabia-Gonzalez
- Sociedad Mexicana de Calidad en Salud SOMECASA, Av. Universidad 3000, C.U., Coyoacan, Ciudad de México 04510, México
| | - Héctor Arreola-Ornelas
- Tómatelo a Pecho A.C., Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, Ciudad de México 14610, México.,Mexican Health Foundation (FUNSALUD), Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, Ciudad de México 14610, México.,Centro de Investigación en Ciencias de la Salud Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac 46, Lomas Anáhuac, Naucalpan de Juárez 52786, Mexico
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, Montrose Road 6, Kingston, Jamaica
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47
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Anacak Y, Zubizarreta E, Zaghloul M, Laskar S, Alert J, Gondhowiardjo S, Giselvania A, Correa-Villar R, Pedrosa F, Dorj B, Kamer S, Howard SC, Quintana Y, Ribeiro RC, Rosenblatt E, Hopkins K. The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study. Clin Oncol (R Coll Radiol) 2020; 33:e211-e220. [PMID: 33250288 DOI: 10.1016/j.clon.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
AIMS Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' MATERIALS AND METHODS A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. RESULTS Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. CONCLUSIONS Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.
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Affiliation(s)
- Y Anacak
- Ege University School of Medicine, Izmir, Turkey
| | | | - M Zaghloul
- National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt
| | - S Laskar
- Tata Memorial Hospital, Mumbai, India
| | - J Alert
- Instituto de Oncología y Radiobiología, Habana, Cuba
| | - S Gondhowiardjo
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - A Giselvania
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - F Pedrosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - B Dorj
- National Cancer Centre, Ulaanbaatar, Mongolia
| | - S Kamer
- Ege University School of Medicine, Izmir, Turkey
| | - S C Howard
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - R C Ribeiro
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - E Rosenblatt
- International Atomic Energy Agency, Vienna, Austria
| | - K Hopkins
- International Atomic Energy Agency, Vienna, Austria.
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48
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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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49
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Mezgebu E, Berhan E, Deribe L. Predictors of Resilience Among Parents of Children with Cancer: Cross-Sectional Study. Cancer Manag Res 2020; 12:11611-11621. [PMID: 33235494 PMCID: PMC7678500 DOI: 10.2147/cmar.s276599] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/04/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Resilience is an ability to overcome adversities in response to a potentially traumatic event. It relieves parents’ discomfort and builds personal capacity when facing a stressful situation like childhood cancer. Therefore, the study’s objective is to assess the magnitude of resilience and its predictors among the parents of children with cancer at Jimma medical center, Ethiopia, 2020. Methods The institutional-based cross-sectional design was employed on 126 parents of children with cancer at Jimma Medical Center. All study populations who attend the hospital from February 25 to April 25, 2020, and fulfill the inclusion criteria were included. Data were entered into Epi data version 4.6.0.2 and analyzed by SPSS version 25. Descriptive analysis was used to describe the study variables. Furthermore, linear regression analysis was calculated to assess predictors of resilience. Results The level of resilience among parents’ children with cancer were a mean scored 51.41±12.02. In this study, factors associated with resilience were receiving support from friends (β=5.67, 95% CI=1.58, 9.77; P=0.007), attend recreational activities (β=13.8, 95% CI=5.32, 22.37; P=0.03) and receiving health information from health care professionals (β=6.37; 95% CI= (1.75, 11.00), P=0.007), parents depression (β= −0.827, 95% CI= (−1.619,-0.034), P=0.041) and parents stress (β =−0.88,95% CI (−1.54,-0.23), P=0.031). Conclusion The magnitude of resilience among parents of children with cancer was low relative to other studies. Support from friends, attending recreational activities, and receiving health information from health care professionals were positively associated with resilience. In contrast, parents’ depression and stress were negatively associated with resilience.
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Affiliation(s)
| | - Emebet Berhan
- Addis Ababa University College of Health Science, School of Nursing and Midwifery, Addis Ababa, Ethiopia
| | - Leul Deribe
- Addis Ababa University College of Health Science, School of Nursing and Midwifery, Addis Ababa, Ethiopia
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50
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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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