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Duffy C, Hunger SP, Bhakta N, Denburg AE, Antillon F, Barr RD. Curing pediatric cancer: A global view. Examples from acute lymphoblastic leukemia. Cancer 2024; 130:2247-2252. [PMID: 38552145 DOI: 10.1002/cncr.35290] [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: 06/09/2024]
Abstract
There is a substantial difference in observed survival among children with acute lymphoblastic leukemia in high‐income countries versus those in low‐ and middle‐income countries. This gap can be reduced considerably by multilevel investing in health systems and services with innovative frameworks such as implementation science.
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Affiliation(s)
- Caitlyn Duffy
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephen P Hunger
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nickhill Bhakta
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and Francisco Marroquín University, Guatemala City, Guatemala
| | - Ronald D Barr
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
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2
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Johnson SE, Samson M. Cancer stigma: the need for policy and programmatic action. J Natl Cancer Inst Monogr 2024; 2024:45-50. [PMID: 38836525 DOI: 10.1093/jncimonographs/lgae014] [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: 10/27/2023] [Revised: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 06/06/2024] Open
Abstract
Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.
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Affiliation(s)
| | - Mélanie Samson
- Capacity Building, Union for International Cancer Control, Geneva, Switzerland
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Ben-Arye E, Samuels N, Seifert G, Gressel O, Peleg R, Jong M. Integrative Medicine Across the Pediatric Cancer Care Trajectory: A Narrative Review. Curr Oncol Rep 2024; 26:714-734. [PMID: 38733465 PMCID: PMC11169001 DOI: 10.1007/s11912-024-01538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF THE REVIEW Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care. RECENT FINDINGS A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Raviv Peleg
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Integrative Pediatric Medicine Program, Petach Tikva, Israel
| | - Miek Jong
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT, Tromsø, Norway
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Nasir AA, Abdur-Raheem NT, Abdur-Rahman LO, Ibiyeye TT, Sayomi TO, Adedoyin OT, Adeniran JO. Characteristics and Clinical Outcomes of Children With Wilms' Tumour: A 15-year Experience in a Single Centre in Nigeria. J Pediatr Surg 2024; 59:1009-1014. [PMID: 38184433 DOI: 10.1016/j.jpedsurg.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Wilms' tumor (WT) is the most common paediatric renal tumor and is one of the most treatment-responsive solid tumours. Survival from Wilms tumour (WT) in sub-Saharan Africa remains dismal as a result of late presentation, treatment abandonment and infrastructure deficit. The purpose of this study was to analyze the clinical outcome of children with Wilms tumour managed in a Nigerian referral centre over a 15-year period. METHODS This is a retrospective study of children with WT (nephroblastoma) who were treated at our institution between January 2006 and December 2020. Clinical characteristics, treatments, and outcomes were analyzed. RESULTS Thirty-five patients were identified. The median age at diagnosis was 36 months including 22 (62.9 %) females. Twenty-six (74.3 %) had advanced (stage III & IV) disease. Confirmatory histology was available for 16 patients ((45.7 %) among which 10 (62.5 %) were mixed type. The right kidney was affected in 18 patients (51.4 %), left in 15 (42.9 %) and 2 were not documented. Preoperative chemotherapy was given in 22 (62.9 %) patients and 13 (37.1) patients had primary nephrectomy. Eight (22.9 %) patients died during treatment (from disease or treatment related causes), and one abandoned treatment. A total of 26 patients completed treatment. Out of these, 8 (30.8 %) were lost to follow up, four patients died and 14 (53.8 %) patients survived at a median follow-up period of 18 months. The survival decreased with advancing stages of the disease, p = 0.002. CONCLUSIONS Majority of children with Wilms tumour in our practice presented with advanced disease. Death during treatment, treatment abandonment and lost to follow up were common. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Retrospective Study.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Nurudeen T Abdur-Raheem
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman O Abdur-Rahman
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Tolulope O Sayomi
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Division of Nephrology, Department of Paediatric, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - James O Adeniran
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Alqudimat MR, Toupin April K, Jibb L, Victor C, Nathan PC, Stinson J. Assessment of complementary health approaches use in pediatric oncology: Modification and preliminary validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) questionnaires. PLoS One 2024; 19:e0294393. [PMID: 38446765 PMCID: PMC10917275 DOI: 10.1371/journal.pone.0294393] [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: 11/12/2022] [Accepted: 11/01/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Complementary Health Approaches (CHA) are commonly used by children with cancer; however, a few health care providers (HCPs) inquire about the use of CHA. A standardized questionnaire could facilitate such clinical discussions. We aimed to adapt and determine the face and content validity of the "Which Health Approaches and Treatments are you using?" (WHAT) child and parent-report questionnaires in pediatric oncology. METHODS An electronic Delphi survey that included children with cancer (8-18 years), parents, and HCPs and CHA researchers was conducted to reach consensus on the content of the WHAT questionnaires in pediatric oncology. Children and parents from the Hospital for Sick Children (SickKids), and HCPs and researchers from the International Society of Pediatric Oncology and Pediatric Complementary and Alternative Medicine Research and Education Network completed the survey. To determine the face and content validity of the questionnaires, two iterative cycles of individual interviews were conducted with purposive samples of children (8-18 years), parents, and HCPs from SickKids. RESULTS Consensus was reached on all domains and items of the original WHAT questionnaires after one Delphi cycle (n = 61). For face and content validity testing, the first cycle of interviews (n = 19) revealed that the questionnaires were mostly comprehensive and relevant. However, the paper-based format of the original WHAT was not user-friendly, and generic items were vague and not aimed at facilitating clinical dialogues about CHA use. The WHAT questionnaires were then modified into electronic cancer-specific self- and proxy-report questionnaires including 13 and 15 items, respectively. The second cycle (n = 21) showed no need for further changes. CONCLUSIONS The modified electronic cancer-specific WHAT questionnaires showed adequate face and content validity. The next step is to determine inter-rater reliability, construct validity, and feasibility of administration of the modified WHAT questionnaires in pediatric oncology.
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Affiliation(s)
- Mohammad R. Alqudimat
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karine Toupin April
- School of Rehabilitation Sciences and Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute and Institute du Savoir Montfort, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsay Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul C. Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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McNeil MJ, Garcia Quintero X, Gonzalez M, Zheng Y, Ugaz Olivares C, Morales R, Boldrini E, Rebollo de Campos D, Ferreira D, Coopasamy K, Caneba J, Padernilla ML, Friedrichsdorf S, Baker JN, Friedrich P. Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries. Cancers (Basel) 2024; 16:1025. [PMID: 38473383 DOI: 10.3390/cancers16051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
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Affiliation(s)
- Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Miriam Gonzalez
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yawen Zheng
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Roxana Morales
- Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Daiane Ferreira
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Joliza Caneba
- Philippines General Hospital, Manila 1000, Philippines
| | | | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA 94305, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Ramírez-Melo JL, Moreira DC, Orozco-Alvarado AL, Sánchez-Zubieta F, Navarro-Martín del Campo RM. Challenges in treating children with optic pathway gliomas: an 18-year experience from a middle-income country. Front Oncol 2024; 14:1329729. [PMID: 38414749 PMCID: PMC10898851 DOI: 10.3389/fonc.2024.1329729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Patients with optic pathway gliomas (OPG) have good survival rates although their long-term quality of life can be affected by the tumor or treatment-related morbidity. This retrospective study sought to describe the clinical presentation and outcomes of children with OPG at a tertiary center in Mexico. Methods Consecutive patients <18 years-of-age with newly diagnosed OPG between January 2002 and December 2020 at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca in Guadalajara, Mexico were included. Results Thirty patients were identified with a median age of six years. The most frequent clinical manifestations were loss of visual acuity (40%) and headaches (23%). Neurofibromatosis-1 was found in 23.3% of the patients. Surgery, either biopsy or resection, was done in 20 of 30 patients. Two patients died shortly after initial surgery. The 5-year event-free survival (EFS) was 79.3% ± 10.8% and the 5-year overall survival was 89.5% ± 6.9%. Lower EFS was associated with age less than 3 years, intracranial hypertension at presentation, and diencephalic syndrome. Patients who received surgery as first-line treatment had a 3.1 times greater risk of achieving a performance score of less than 90 points at 6 months after diagnosis (p=0.006). Of 10 patients with vision testing, 5 had improvement in visual acuity, 4 had no changes, and one patient showed worsening. Conclusion Our data suggests that favorable outcomes can be achieved with OPG in low- and middle-income countries, although a high rate of surgical complications was described leading to a lower overall survival. These data can be used prospectively to optimize treatment at this institute and other middle-income countries through a comprehensive, multidisciplinary approach.
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Affiliation(s)
- Jorge Luis Ramírez-Melo
- Pediatric Oncology and Hematology Service, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Mexico
| | - Daniel C. Moreira
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ana Luisa Orozco-Alvarado
- Pediatric Oncology and Hematology Service, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Mexico
| | - Fernando Sánchez-Zubieta
- Pediatric Oncology and Hematology Service, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Mexico
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Sharma R, Abbastabar H, Abdulah DM, Abidi H, Abolhassani H, Abrehdari-Tafreshi Z, Absalan A, Ali HA, Abu-Gharbieh E, Acuna JM, Adib N, Sakilah Adnani QE, Aghaei A, Ahmad A, Ahmad S, Ahmadi A, Ahmadi S, Ahmed LA, Ajami M, Al Hamad H, Al Hasan SM, Alanezi FM, Saeed Al-Gheethi AA, Al-Hanawi MK, Ali A, Ali BA, Alimohamadi Y, Aljunid SM, Ali Al-Maweri SA, Alqahatni SA, AlQudah M, Al-Raddadi RM, Al-Tammemi AB, Ansari-Moghaddam A, Anwar SL, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Ariffin H, Artaman A, Arulappan J, Ashraf T, Askari E, Athar M, Wahbi Atout MM, Azadnajafabad S, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Bai R, Bajbouj K, Baliga S, Bardhan M, Bashiri A, Baskaran P, Basu S, Belgaumi UI, Nazer C Bermudez A, Bhandari B, Bhardwaj N, Bhat AN, Bitaraf S, Boloor A, Hashemi MB, Butt ZA, Chadwick J, Kai Chan JS, Chattu VK, Chaturvedi P, Cho WC, Darwesh AM, Dash NR, Dehghan A, Dhali A, Dianatinasab M, Dibas M, Dixit A, Dixit SG, Dorostkar F, Dsouza HL, Elbarazi I, Elemam NM, El-Huneidi W, Elkord E, Abdou Elmeligy OA, Emamian MH, Erkhembayar R, Ezzeddini R, Fadoo Z, Faiz R, Fakhradiyev IR, Fallahzadeh A, Faris MEM, Farrokhpour H, Fatehizadeh A, Fattahi H, Fekadu G, Fukumoto T, Gaidhane AM, Galehdar N, Garg P, Ghadirian F, Ghafourifard M, Ghasemi M, Nour MG, Ghassemi F, Gholamalizadeh M, Gholamian A, Ghotbi E, Golechha M, Goleij P, Goyal S, Mohialdeen Gubari MI, Gunasekera DS, Gunawardane DA, Gupta S, Habibzadeh P, Haeri Boroojeni HS, Halboub ES, Hamadeh RR, Hamoudi R, Harorani M, Hasanian M, Hassan TS, Hay SI, Heidari M, Heidari-Foroozan M, Hessami K, Hezam K, Hiraike Y, Holla R, Hoseini M, Hossain MM, Hossain S, Hsieh VCR, Huang J, Hussein NR, Hwang BF, Iravanpour F, Ismail NE, Iwagami M, Merin J L, Jadidi-Niaragh F, Jafarinia M, Jahani MA, Jahrami H, Jaiswal A, Jakovljevic M, Jalili M, Jamshidi E, Jayarajah U, Jayaram S, Jha SS, Jokar M, Joseph N, Kabir A, Kabir MA, Kadir DH, Kakodkar PV, Kalankesh LR, Kalankesh LR, Kalhor R, Kaliyadan F, Kamal VK, Kamal Z, Kamath A, Kar SS, Karimi H, Kaur N, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khan EA, Khan MN, Khan M, Khan MA, Khan YH, Khanmohammadi S, Khatatbeh MM, Khateri S, Khayamzadeh M, Khayat Kashani HR, Kim MS, Kompani F, Koohestani HR, Koulmane Laxminarayana SL, Krishan K, Kumar N, Kumar N, Kutluk T, Kuttikkattu A, Ching Lai DT, Lal DK, Lami FH, Lasrado S, Lee SW, Lee SW, Lee YY, Lee YH, Leong E, Li MC, Liu J, Madadizadeh F, Mafi AR, Mahjoub S, Malekzadeh R, Malik AA, Malik I, Mallhi TH, Mansournia MA, Martini S, Mathews E, Mathur MR, Meena JK, Menezes RG, Mirfakhraie R, Mirinezhad SK, Mirza-Aghazadeh-Attari M, Mithra P, Mohamadkhani A, Mohammadi S, Mohammadzadeh M, Mohan S, Mokdad AH, Al Montasir A, Montazeri F, Moradi M, Sarabi MM, Moradpour F, Moradzadeh M, Moraga P, Mosapour A, Motaghinejad M, Mubarik S, Muhammad JS, Murray CJ, Nagarajan AJ, Naghavi M, Nargus S, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen PT, Niazi RK, Noroozi N, Okati-Aliabad H, Okekunle AP, Ong S, Oommen AM, Padubidri JR, Pandey A, Park EK, Park S, Pati S, Patil S, Paudel R, Paudel U, Pirestani M, Podder I, Pourali G, Pourjafar M, Pourshams A, Syed ZQ, Radhakrishnan RA, Radhakrishnan V, Rahman M, Rahmani S, Rahmanian V, Ramesh PS, Rana J, Rao IR, Rao SJ, Rashedi S, Rashidi MM, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Roshandel G, Chandan S, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Saeed U, Safi SZ, Sharif-Askari FS, Sahebkar A, Sahoo H, Sajedi SA, Sajid MR, Salehi MA, Farrokhi AS, Sarasmita MA, Sargazi S, Sarode GS, Sarode SC, Sathian B, Satpathy M, Semwal P, Senthilkumaran S, Sepanlou SG, Shafeghat M, Shahabi S, Shahbandi A, Shahraki-Sanavi F, Shaikh MA, Shannawaz M, Sheikhi RA, Shobeiri P, Shorofi SA, Shrestha S, Siabani S, Singh G, Singh P, Singh S, Sinha DN, Siwal SS, Sreeram S, Suleman M, Abdulkader RS, Sultan I, Sultana A, Tabish M, Tabuchi T, Taheri M, Talaat IM, Tehrani-Banihashemi A, Temsah MH, Thangaraju P, Thomas N, Thomas NK, Tiyuri A, Tobe-Gai R, Toghroli R, Tovani-Palone MR, Ullah S, Unnikrishnan B, Upadhyay E, Tahbaz SV, Valizadeh R, Varthya SB, Waheed Y, Wang S, Wickramasinghe DP, Wickramasinghe ND, Xiao H, Yonemoto N, Younis MZ, Yu C, Zahir M, Zaki N, Zamanian M, Zhang ZJ, Zhao H, Zitoun OA, Zoladl M. Temporal patterns of cancer burden in Asia, 1990-2019: a systematic examination for the Global Burden of Disease 2019 study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100333. [PMID: 38361599 PMCID: PMC10866992 DOI: 10.1016/j.lansea.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year-wise estimates of incidence, mortality, and disability-adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age-specific incidence rates. Findings All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The age-standardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age-standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4-folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age-standardized DALYs rate was 2970.5/100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top-5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age-standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019. Interpretation With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early-stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control. Funding The GBD study is funded by the Bill and Melinda Gates Foundation.
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Farrag A, Mohammed K, Ghazaly MH, Berthold F. Noncompliance of pediatric cancer patients with chemotherapy: A single-center experience in a lower-middle income country. Pediatr Hematol Oncol 2024; 41:41-53. [PMID: 37740941 DOI: 10.1080/08880018.2023.2256780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
Noncompliance with therapy is a big obstacle to successful therapy. We aimed to evaluate the prevalence and risk factors affecting the compliance of pediatric cancer patients with therapy in a tertiary care center far away from the capital in a lower-middle income country (LMIC). A retrospective cohort study of reports of all pediatric cancer patients who were diagnosed and started treatment between 2006 and 2010 at South Egypt Cancer Institute (SECI) was done. The following data were collected: Age, sex, diagnosis, compliance with therapy, and data on potential risk factors that might affect compliance, including time duration of travel from the patient's home to SECI, time lag between the first symptom until the first visit to SECI and until the start of treatment, results of reevaluation after the initial course of therapy, and therapy-related severe adverse events. Noncompliance with therapy was defined as when patients missed their determined therapy appointment for one week or more or abandoned therapy. This study included 510 patients. Eighty-three (16.3%) were non-compliant, as forty patients missed their therapy appointment (7.8%), and 43 abandoned further therapy (8.4%). Noncompliance was found to be more prevalent among patients with solid tumors. Non-compliant patients suffered a significantly higher relapse rate (47.7% vs. 11.2% in compliant patients, p < .001). Unfortunately, 75% of the abandoned patients who returned for further therapy suffered a relapse. Noncompliance with treatment is still a big problem facing cancer management in LMICs.
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Affiliation(s)
- A Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Children's Hospital, Lucerne, Switzerland
| | - K Mohammed
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M H Ghazaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - F Berthold
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
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10
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Luna-Fineman S, Castellanos M, Metzger ML, Baez LF, Peña Hernandez A, Bonilla M, Fuentes-Alabi S, Nieves R, Blanco J, Rossi E, Devidas M, Chen Y, Arreola M, de Alarcon PA. Treatment of high-risk Hodgkin lymphoma with a modified Stanford V regimen in the AHOPCA: Substituting chemotherapy agents and hampered outcomes. Pediatr Blood Cancer 2024; 71:e30792. [PMID: 38053237 DOI: 10.1002/pbc.30792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND/OBJECTIVES High-risk Hodgkin lymphoma (HRHL) in children is curable with combined modality therapy. The Association of Pediatric Hematology-Oncology of Central America (AHOPCA) is a consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics, and radiation guidelines, aimed at reducing abandonment and improving outcomes. METHODS Newly diagnosed children less than 18 years of age with high-risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest radiography and ultrasound or computed tomography. Therapy was a modified Stanford V (mStanfordV), substituting cyclophosphamide for mechlorethamine and involved field radiation. RESULTS Of 219 patients with HRHL, 181 patients were eligible and evaluable; 146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB, and 54 IV. Thirty-one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed, and eight (4%) died of toxicity. Radiation guidelines were not followed. Five-year abandonment-sensitive event-free survival and overall survival (AS-EFS, AS-OS ± SE) for the cohort were 46% ± 4% and 56% ± 4%; 5-year AS-OS for stages IIB, IIIB, and IV was 76% ± 7%, 59% ± 7%, and 35% ± 7% (p = .0006). CONCLUSION Despite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of Stanford V. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccurate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.
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Affiliation(s)
- Sandra Luna-Fineman
- Hematology/Oncology/SCT, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | | | - L Fulgencio Baez
- Oncología Pediátrica, Hospital Manuel de Jesús Rivera "La Mascota", Managua, Nicaragua
| | - Armando Peña Hernandez
- Oncología Pediátrica, Hospital Escuela Universitario Materno Infantil, Tegucigalpa, Honduras
| | - Miguel Bonilla
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Soad Fuentes-Alabi
- Oncología Pediátrica, Hospital de Niños Benjamín Bloom, Centro Médico "Ayúdame a Vivir", San Salvador, El Salvador
| | - Rosa Nieves
- Oncología Pediátrica, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Jessica Blanco
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
- Center for Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuela Rossi
- Center for Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Meenakshi Devidas
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yichen Chen
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Magda Arreola
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
| | - Pedro A de Alarcon
- Department of Pediatrics, University of Illinois College of Medicine and St Jude Midwest Affiliate Children's Hospital of Illinois, Peoria, Illinois, USA
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11
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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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12
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Killela M, Biddell C, Keim-Malpass J, Schwartz TA, Soto S, Williams J, Santacroce S. The Use of Medical Crowdfunding to Mitigate the Personal Costs of Serious Chronic Illness: Scoping Review. J Med Internet Res 2023; 25:e44530. [PMID: 38048149 PMCID: PMC10697184 DOI: 10.2196/44530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. OBJECTIVE This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology. RESULTS Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples' experiences with MCF. CONCLUSIONS The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking.
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Affiliation(s)
- Mary Killela
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Todd A Schwartz
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandra Soto
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sheila Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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13
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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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14
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Rajagopal R, Teng AJ, Jawin V, Wong OL, Mahsin H, Abd Rani NH, Yap TY, Gunasagaran K, Thevarajah A, Yeoh SL, Ong GB, Ariffin H, Jones D, Bouffet E, Gottardo NG. Prognostic significance of molecular subgroups in survival outcome for children with medulloblastoma in Malaysia. Front Oncol 2023; 13:1278611. [PMID: 37920166 PMCID: PMC10619898 DOI: 10.3389/fonc.2023.1278611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Advancements in genomic profiling led to the discovery of four major molecular subgroups in medulloblastoma (MB), which have now been incorporated into the World Health Organization classification of central nervous system tumors. The current study aimed to determine the prognostic significance of the MB molecular subgroups among children in Malaysia. Methods We assembled MB samples from children <18 years between January 2003 and June 2017 from four pediatric oncology centers in Malaysia. MB was sub-grouped using 850k DNA methylation testing at German Cancer Research Centre, Heidelberg, Germany. Results Fifty samples from patients diagnosed and treated as MB were identified. Two (4%) of the 50 patients' tumor DNA samples were insufficient for analysis. Of the remaining 48 patients, 41 (85%) samples were confirmed as MB, while for 7 (15%) patients, DNA methylation classification results were discrepant with the histopathological diagnosis of MB, with various other diagnoses. Of the 41 MB patients, 15 patients were stratified as standard-risk (SR), 16 patients as high-risk (HR), and ten as infants (age <3 years old). Molecular subgrouping of the whole cohort revealed four (14%) WNT, 11 (27%) SHH, 10 (24%) Group 3, and 16 (39%) Group 4. Treatment abandonment rates for older children and infants were 22.5% and 10%, respectively. After censoring treatment abandonment, for SR patients, the 5-year event-free survival (EFS) and overall survival (OS) were 43.1% ± 14.7% and 46.9 ± 15.6%, respectively, while in HR, 5-year EFS and OS were both 63.6% ± 14.5%. Infants had a 5-year EFS and OS of 55.6% ± 16.6% and 66.7% ± 15.7%, respectively. WNT tumors had the best 5y-OS, followed by Group 3, Group 4, and SHH in children ≥3 years old. In younger children, SHH MB patients showed favorable outcomes. Conclusion The study highlights the importance of DNA methylation profiling for diagnostic accuracy. Most infants had SHH MB, and their EFS and OS were comparable to those reported in high-income countries. Due to the relatively small cohort and the high treatment abandonment rate, definite conclusions cannot be made regarding the prognostic significance of molecular subgroups of MB. Implementing this high-technology investigation would assist pathologists in improving the diagnosis and provide molecular subgrouping of MB, permitting subgroup-specific therapies.
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Affiliation(s)
- Revathi Rajagopal
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ay Jiuan Teng
- Division of Hematology and Oncology, Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Vida Jawin
- Division of Hematology and Oncology, Department of Pediatrics, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bharu, Malaysia
| | - Oy Leng Wong
- Department of Pathology, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Hakimah Mahsin
- Department of Pathology, Penang General Hospital, Ministry of Health Malaysia, George Town, Malaysia
| | - Nor Haizura Abd Rani
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Tsiao Yi Yap
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Kogilavani Gunasagaran
- Division of Hematology and Oncology, Department of Pediatrics, Sabah Woman and Children’s Hospital, Ministry of Health, Kota Kinabalu, Malaysia
| | - Asohan Thevarajah
- Division of Hematology and Oncology, Department of Pediatrics, Sabah Woman and Children’s Hospital, Ministry of Health, Kota Kinabalu, Malaysia
| | - Seoh Leng Yeoh
- Division of Hematology and Oncology, Department of Pediatrics, Penang General Hospital, Ministry of Health Malaysia, George Town, Malaysia
| | - Gek Bee Ong
- Division of Hematology and Oncology, Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Hany Ariffin
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - David Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Centre, Heidelberg, Germany
| | - Eric Bouffet
- Division of Neuro-oncology, Department of Pediatric Hematology and Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas G. Gottardo
- Department of Pediatric and Adolescent Oncology/Hematology, Perth Children’s Hospital, Nedlands, Perth, WA, Australia
- Brain Tumor Research Program, Telethon Kids Institute University of Western Australia, Nedlands, Perth, WA, Australia
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15
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Moreira DC, González-Ramella O, Echavarría Valenzuela M, Carrillo AK, Faughnan L, Job G, Chen Y, Villegas C, Ellis Irigoyen A, Barra Urbays R, Ramírez Martinez M, Altamirano Alvarez E, León Espitia JA, López Facundo NA, Colunga Pedraza JE, Reyes Gutierrez FDM, Aguilar Román AB, Tamez Gómez EL, Portillo Zavala CS, Negroe Ocampo NDC, Pulido Sanchez SG, Cortés Alva D, Casillas Toral P, Salas Villa K, Mendoza Sánchez PJ, Pérez Alvarado C, Tamayo Pedraza G, González Zamorano M, Ávila Alba JMR, Becerril Becerril J, Ramírez Durán H, Sandoval Cabrera A, Pineda Gordillo A, de la Rosa Alonso DI, Mejía Marín LJ, Benítez Can LDLÁ, Gutiérrez Martinez I, Jiménez Osorio MI, Echeandia N, Casillas E, Guerrero-Gomez K, Devidas M, Friedrich P. Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients. Front Oncol 2023; 13:1255555. [PMID: 37790759 PMCID: PMC10544893 DOI: 10.3389/fonc.2023.1255555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background and aims Pediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico. Methods Patients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined. Results Overall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1-10 years, with DNA index >0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS. Conclusion Outcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes.
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Affiliation(s)
- Daniel C. Moreira
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Oscar González-Ramella
- Department of Pediatric Hematology/Oncology, Hospital Civil de Guadalajara Juan I. Menchaca, Guadalajara, Mexico
| | | | - Angela K. Carrillo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Lane Faughnan
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Godwin Job
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Cesar Villegas
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Andrea Ellis Irigoyen
- Department of Pediatric Oncology, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | - Rosario Barra Urbays
- Department of Pediatric Oncology, Centro Estatal de Cancerologia Dr. Miguel Dorantes Mesa, Xalapa, Mexico
| | | | - Eduardo Altamirano Alvarez
- Department of Pediatric Hematology/Oncology, Hospital General con Especialidades “Juan María Salvatierra”, La Paz, Mexico
| | | | | | | | | | | | - Edna Liliana Tamez Gómez
- Department of Pediatric Hematology/Oncology, Hospital Infantil de Tamaulipas, Ciudad Victoria, Mexico
| | | | | | | | - Deyanira Cortés Alva
- Department of Pediatric Oncology, Hospital del Niño DIF Hidalgo, Pachuca, Mexico
| | - Paola Casillas Toral
- Department of Pediatric Hematology/Oncology, Hospital Civil de Guadalajara Juan I. Menchaca, Guadalajara, Mexico
| | - Karime Salas Villa
- Department of Pediatric Oncology, Hospital Pediátrico de Sinaloa, Culiacán, Mexico
| | | | - Carlos Pérez Alvarado
- Department of Pediatric Oncology, Centro Estatal de Cancerologia Dr. Miguel Dorantes Mesa, Xalapa, Mexico
| | | | - Margarita González Zamorano
- Department of Pediatric Hematology/Oncology, Hospital General con Especialidades “Juan María Salvatierra”, La Paz, Mexico
| | | | | | - Hernán Ramírez Durán
- Department of Pediatric Hematology, Hospital Universitario “José Eleuterio González”, Monterrey, Mexico
| | | | | | | | | | | | - Itzel Gutiérrez Martinez
- Department of Pediatric Hematology, Hospital Infantil de Morelia “Eva Sámano de López Mateos”, Morelia, Mexico
| | | | - Naomi Echeandia
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | | | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Pramesh CS, Sengar M, Patankar S, Chinnaswamy G, Gupta S, Vijayakumar M, Sood S, Sathe AN, Radhakrishnan V, Ganesan P, Mallavarapu KM, Badwe RA. A National Cancer Grid pooled procurement initiative, India. Bull World Health Organ 2023; 101:587-594. [PMID: 37638358 PMCID: PMC10452934 DOI: 10.2471/blt.23.289714] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 08/29/2023] Open
Abstract
In health systems with little public funding and decentralized procurement processes, the pricing and quality of anti-cancer medicines directly affects access to effective anti-cancer therapy. Factors such as differential pricing, volume-dependent negotiation and reliance on low-priced generics without any evaluation of their quality can lead to supply and demand lags, high out-of-pocket expenditures for patients and poor treatment outcomes. While pooled procurement of medicines can help address some of these challenges, monitoring of the procurement process requires considerable administrative investment. Group negotiation to fix prices, issuing of uniform contracts with standardized terms and conditions, and procurement by individual hospitals also reduce costs and improve quality without significant investment. The National Cancer Grid, a network of more than 250 cancer centres in India, piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This study reveals the advantages of group negotiation in pooled procurement for high-value medicines, an approach that can be applied to other health systems.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Hospital, Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai400012, India
| | - Manju Sengar
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | - Sumedha Patankar
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | - M Vijayakumar
- Zulekha Yenepoya Institute of Oncology, Yenepoya (Deemed to be university), Mangalore, India
| | - Sanjeev Sood
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | - Anil N Sathe
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
| | | | - Prasanth Ganesan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Rajendra A Badwe
- Tata Memorial Centre, affiliated with the Homi Bhabha National Institute, Mumbai, India
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17
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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [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: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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18
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Amini M, Sharma R, Jani C. Gender differences in leukemia outcomes based on health care expenditures using estimates from the GLOBOCAN 2020. Arch Public Health 2023; 81:151. [PMID: 37605241 PMCID: PMC10440892 DOI: 10.1186/s13690-023-01154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Leukemia contributes significantly to the global cancer burden. Due to the importance of evaluating improvements in leukemia outcomes, the current study aimed to examine the variations in mortality-to-incidence ratio (MIR) between genders and association of MIR with the health expenditures in selected countries. METHODS The leukemia incidence and mortality rates were extracted from the GLOBOCAN 2020 database. In total, 56 countries were included based on the data quality reports and the exclusion of missing data. The associations of MIR and changes in MIR over time ([Formula: see text]MIR) with the human development index (HDI), current health expenditure (CHE) per capita, and current health expenditure as a percentage of gross domestic product (CHE/GDP) were investigated using Spearman's rank correlation coefficient. RESULTS In 2020, an estimated 474,519 new cases of leukemia were diagnosed globally, and 311,594 deaths occurred due to the disease. Male patients exhibited a higher incidence and mortality of leukemia compared to females on a global scale. Our analysis revealed that the MIRs were the highest and lowest in Egypt (0.79) and the United States (0.29), respectively. Remarkably, countries with greater HDI, higher CHE per capita, and a higher CHE/GDP tended to have lower MIR in both genders and within gender-specific subgroups. The δMIR demonstrated a significant negative correlation with HDI and CHE per capita, whereas no significant associations were observed among female patients for CHE/GDP. Besides, all three indicators showed trends towards negative correlations with δMIR among males, though these trends were not statistically significant (p>0.05). CONCLUSIONS Generally, leukemia MIRs tended to be most favorable (i.e., lower) in countries with high HDI and high health expenditure. The gender differences observed in leukemia outcomes may reflect the potential influence of social, material, behavioral, and biological factors.
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Affiliation(s)
- Maedeh Amini
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Rajesh Sharma
- Humanities and Social Sciences, National Institute of Technology Kurukshetra, Kurukshetra, India
| | - Chinmay Jani
- Mount Aubrun Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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19
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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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20
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Joseph LL, Srinivasan HN, Robert M, Boddu D, John R, Mathew LG, Totadri S. The Nutritional Trajectory of Children with Acute Lymphoblastic Leukemia: A 10-Year Follow up Study from a Referral Center in South India. Nutr Cancer 2023; 75:678-684. [PMID: 36444754 DOI: 10.1080/01635581.2022.2152194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to late adverse events such as obesity and an associated metabolic syndrome. METHODS Children treated for ALL from 2002 to 2012 were included. BMI was calculated at diagnosis, end of treatment, and 5, 8, and 10-years from diagnosis. BMI-centiles were used to categorize the patients: underweight (<5th-percentile), normal (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th centile). RESULTS The study included 179 children with ALL (median age: 59-months). The proportions of patients who were underweight, normal, overweight/obese, were 37%, 56% and 7%, respectively, at diagnosis; and 15%, 51% and 34%, respectively, at 5-years from diagnosis. The median (IQR) BMI Z-score at diagnosis was -1.12(-2.40, -0.26). The median (IQR) BMI z-score of the cohort was higher after 5 [0.22(-0.83,1.24), P < 0.001] and 10-years of diagnosis [0.30(-0.69,0.99), P < 0.001], respectively. The proportion of overweight/obese individuals was higher after 5 (34%, P < 0.001) and 10 (26%, P = 0.001) years. There was a significant correlation between the baseline BMI Z-score and that observed after 5-years (ρ = 0.49, P < 0.001), and 10-years (ρ = 0.55, P < 0.001). CONCLUSION At 10-years of follow-up, >25% of children with ALL were overweight/obese. The BMI Z-score at the time of diagnosis continued to correlate with the Z-score after 10-years.
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Affiliation(s)
- Leenu Lizbeth Joseph
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Hema Nalapullu Srinivasan
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Magdalenal Robert
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Deepthi Boddu
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Rikki John
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Leni Grace Mathew
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Sidharth Totadri
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
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21
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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Landscape of pediatric cancer treatment refusal and abandonment in the US: A qualitative study. Front Pediatr 2023; 10:1049661. [PMID: 36699305 PMCID: PMC9869139 DOI: 10.3389/fped.2022.1049661] [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: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To describe United States (US) pediatric oncologists' experiences with treatment refusal or abandonment, exploring types and frequency of decision-making conflicts, and their impact. Study design We conducted exploratory qualitative interviews of pediatric oncologists (n = 30) with experience caring for a pediatric patient who refused or abandoned curative treatment. Interviewees were recruited using convenience and nominated expert sampling, soliciting experiences from diverse geographic locations and institution sizes across the US. We analyzed transcripts using applied thematic analysis to identify and refine meaningful domains. Results Many oncologists reported multiple experiences with refusal and abandonment. Most anticipated case frequency would increase due to misinformation, particularly on the internet. Interviewees described cases of treatment refusal and abandonment, but also a wider variety of cases than previously described in existing publications, including cases involving: non-adherence; negotiations for different treatments; negotiations for complementary and alternative medicine; delayed treatment initiation; and refusal of a component of recommended therapy. Cases often involved multiple stages or types of conflicts. Recurring patient/family behaviors emerged: clear opposition to treatment from the outset; hesitancy about treatment despite initiating therapy; and psychosocial circumstances becoming an obstacle to treatment completion. Oncologists revealed substantial professional and personal repercussions of these cases. Conclusion Oncologist interviews highlight a broad range of conflicts, yielding a taxonomy of treatment refusal, non-adherence and abandonment (TRNA) that accounts for the heterogeneity of situations described. Cases' complexity and interrelatedness points to a functional model of TRNA that includes families' behaviors. This preliminary taxonomy and model warrant further research and examination to refine the model and generate strategies to prevent and mitigate TRNA.
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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22
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Kuek T, Schilling CG, Choong PF. The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach. J Orthop Surg (Hong Kong) 2023; 31:10225536231168989. [PMID: 37053184 DOI: 10.1177/10225536231168989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Extremity sarcoma surgery entails significant costs for patients, governments and insurers. Multiple studies have described individual costs, however, the overall impact of cost on the quality of surgical care remains unclear. OBJECTIVES A narrative review with a systematic approach was undertaken to compare the impact of cost on the quality of extremity sarcoma care across low-middle-income and high-income countries. DATA SOURCES MEDLINE, EMBASE, Cochrane, PsycInfo, DARE, NHS-EED, HTA. METHODS A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were: discussion of costs and the surgical management of primary extremity sarcoma. There were no restrictions on study design, publication type, date, geographic location or publication status. A data extraction table was used to identify study location, type and findings. RESULTS 1012 studies were retrieved and 44 met the inclusion criteria. Four additional studies were identified from the reference lists of included articles. 27 studies were published in high-income countries (HIC) including all four full health economic analyses and 20 studies were published in low-middle income countries (LMC). Within LMC, cost impeded access to diagnosis, resection and options for reconstruction. In HIC, cost varied with choice of management, particularly during the long-term postoperative period. CONCLUSIONS Within LMC, cost impaired the provision of quality, curative care for patients with extremity sarcoma. Within HIC, while costs varied with chosen management, they were not prohibitive to the provision of quality care. Further research is required, specific to both socioeconomic contexts, to further describe the long-term cost-utility of different methods for the surgical management of extremity sarcoma.
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Affiliation(s)
- Timothy Kuek
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Chris G Schilling
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
- Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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23
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Chai CWE, Lau BT, Tee MKT, Al Mahmud A. Evaluating a serious game to improve childhood cancer patients' treatment adherence. Digit Health 2022; 8:20552076221134457. [PMID: 36339903 PMCID: PMC9630903 DOI: 10.1177/20552076221134457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Childhood cancer patients need to have good treatment adherence.
Unfortunately, treatment non-adherence often occurs due to high side-effect
burdens of treatment and the lack of knowledge of one's illness and
treatment. Therefore, a serious game intervention based on the Protection
Motivation Theory (PMT) was designed and developed to motivate childhood
cancer patients to undergo treatment and to motivate them to undergo
treatment, perform daily self-care and educate them about their illness. Methods Childhood cancer patients (6–17 years old) and their caregivers were
recruited in a multi-centre, single-arm intervention in Malaysia. A total of
24 child-caregiver dyads have completed the study. This study used PMT-based
surveys to collect quantitative data regarding children's motivation to
adhere to treatment and perform daily self-care. Additionally, a 20-question
multiple-choice quiz was used to determine children's knowledge levels.
These surveys were conducted pre-test and post-test. Children's and
caregivers' feedback were also gathered post-test as qualitative data. Results The results showed that overall, the children's intention to undergo cancer
treatment had increased significantly. A significant increase in the
intention to perform daily self-care was found among younger children, while
older children showed significant improvement in their cancer knowledge
levels. The post-test feedback suggested that the game was liked by both
children and caregivers and it provided various benefits to children with
cancer. Conclusions Findings suggest that the intervention has the potential to improve childhood
cancer patients’ motivation for treatment adherence and daily self-care, in
addition to educating them about cancer and treatment.
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Affiliation(s)
- Carmen Wang Er Chai
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia,Carmen Chai, Swinburne University of
Technology Sarawak Campus, Jalan Simpang Tiga, 93350 Kuching, Sarawak, Malaysia.
;
| | - Bee Theng Lau
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Mark Kit Tsun Tee
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Abdullah Al Mahmud
- School of Design and Architecture, Swinburne University of
Technology, Melbourne, Victoria, Australia
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Khan MR, Maaz AUR, Ashraf MS. Challenges in the Management of Wilms Tumor in a Developing Country: A Twenty Years' Experience From a Single Center in Pakistan. J Pediatr Hematol Oncol 2022; 44:454-461. [PMID: 35917164 DOI: 10.1097/mph.0000000000002507] [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: 09/10/2021] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wilms Tumor (WT) is one of the most curable childhood cancers. High cure rates seen in the developed countries are not reproduced in developing countries. Lack of access to cancer treatment facilities, financial constraints, late presentation, and abandonment have previously been described. We reviewed our data over the last 20 years to highlight some of these challenges. METHODS This is a retrospective chart review of children with WT at our center up to the age of 18 years between 1 November 1997 and 30 November 2017. Demographic details, presentation characteristics and treatment details were recorded. Factors associated with poor outcome were analyzed. RESULTS Two hundred eleven children were registered; 117(55.5%) were males. Median age at presentation was 3 (range 0 to 18) years. Presentation data were available for 184/211 patients, staging details for 159/211 and metastatic status for 178/211. Of the available dataset, 60% presented without prior treatment, whereas 40% presented atleast after primary surgical excision. High-stage (stage III or above) disease was present in 79 (49.7%) patients; 61 (34.3%) was presented with metastases or recurrence; 63 (29.8%) abandoned or refused treatment; 99/172 (57.6%) patients finished treatment, 23 (13.4%) died during treatment, and 6 died before treatment. Of the 99 patients who finished treatment 83 (83.8%) are well off therapy; 15(15.2%) relapsed; 6 (40%) are alive after salvage therapy, while 9 (60%) died. CONCLUSIONS Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges.
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Affiliation(s)
- Muhammad Rahil Khan
- Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia
| | - Ata Ur Rehman Maaz
- Department of Pediatric Haematology/Oncology, Sidra Medicine, Doha, Qatar
| | - Muhammad Shamvil Ashraf
- Department of Pediatric Haematology/Oncology, Indus Hospital and Health Network, Karachi, Opposite Darussalam Society, Korangi Crossing, Karachi, Pakistan
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Afungchwi GM, Kruger M, Hesseling P, van Elsland S, Ladas EJ, Marjerrison S. Survey of the use of traditional and complementary medicine among children with cancer at three hospitals in Cameroon. Pediatr Blood Cancer 2022; 69:e29675. [PMID: 35441798 DOI: 10.1002/pbc.29675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is lack of diagnostic and treatment resources with variable access to childhood cancer treatment in low- and middle-income countries (LMIC), which may lead to subsequent poor survival. The primary aim of this study was to determine the prevalence and types of traditional and complementary medicine (T&CM) used in Cameroon. Secondarily, we explored determinants of T&CM use, associated costs, perceived benefits and harm, and disclosure of T&CM use to medical team. METHODS A prospective, cross-sectional survey among parents and carers of children younger than 15 years of age who had a cancer diagnosis and received cancer treatment at three Baptist Mission hospitals between November 2017 and February 2019. RESULTS Eighty participants completed the survey. Median patient age was 8.1 years (IQR4.1-11.1). There was significant availability (90%) and use (67.5%) of T&CM, whereas 24% thought T&CM would be good for cancer treatment. Common T&CM remedies included herbs and other plant remedies or teas taken by mouth, prayer for healing purposes and skin cutting. Living more than five hours away from the treatment center (P = 0.030), anticipated costs (0.028), and a habit of consulting a traditional healer when sick (P = 0.006) were associated with the use of T&CM. T&CM was mostly paid for in cash (53.7%) or provided free of charge (29.6%). Of importance was the fact that nearly half (44%) did not want to disclose the use of TM to their doctor. CONCLUSION Pediatric oncology patients used T&CM before and during treatment but were unlikely to disclose its use to the child's health care team.
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Affiliation(s)
- Glenn M Afungchwi
- Childhood Cancer Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon.,Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Peter Hesseling
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine van Elsland
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York
| | - Stacey Marjerrison
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Faculty of Health Sciences, Departments of Pediatric and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Retinoblastoma as a lens for correctable disparities worldwide. THE LANCET GLOBAL HEALTH 2022; 10:e1074-e1075. [DOI: 10.1016/s2214-109x(22)00290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
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Huang J, Chan SC, Ngai CH, Lok V, Zhang L, Lucero‐Prisno DE, Xu W, Zheng Z, Elcarte E, Withers M, Wong MCS. Global incidence, mortality and temporal trends of cancer in children: A joinpoint regression analysis. Cancer Med 2022; 12:1903-1911. [PMID: 35822443 PMCID: PMC9883415 DOI: 10.1002/cam4.5009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/METHODS The Cancer Incidence in Five Continents Time Trends, Nordic Cancer Registries, Surveillance, Epidemiology and End Results, WHO Mortality databases were assessed to extract the Age-Standardised Rates (ASR) of cancer incidence and mortality among children aged 0-14 years old. By using the ASRs, the country-specific Average Annual Percentage Change (AAPC) and its corresponding 95% confidence interval (CI) were calculated to determine the epidemiological cancer trend. RESULTS In 2020, the highest incidence of childhood cancer was found in countries with higher Human Development Index (HDI) (ASR = 15.7), yet the highest mortality was found in countries with lower HDIs (ASR = 4.8). As for incidence, seven countries had positive AAPC among boys; Slovakia (AAPC2001-2010 = 4.98, 95% CI [1.66-8.40]), Ecuador (AAPC2003-2012 = 4.07, 95% CI [0.67-7.59]) and Thailand (AAPC2003-2012 = 3.69, 95% CI [0.37-7.11]) had the highest AAPC. Among girls, three countries had positive AAPC, which included Belarus (AAPC2003-2012 = 3.18, 95% CI [1.11, 5.29]), Canada (AAPC2003-2012 = 2.83, 95% CI [1.60, 4.07]) and Korea (AAPC2003-2012 = 1.76, 95% CI [0.23-3.32]). There was an overall decreasing trend of mortality. However, increased mortality was observed in two countries: Ecuador for boys (AAPC2007-2016 = 1.72, 95% CI [0.27-3.19]) and Austria for girls (AAPC2008-2017 = 4.11, 95% CI [0.38-7.98]). CONCLUSIONS The largest mortality and mortality to incidence ratio of childhood cancer were found in low-income countries. There was a substantial increasing trend of childhood cancer incidence, while overall its mortality has been decreasing over the past decade. More studies are needed to confirm the drivers behind these epidemiologic trends.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Chun Ho Ngai
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Veeleah Lok
- Department of Global Public Health, Karolinska InstituteKarolinska University HospitalStockholmSweden
| | - Lin Zhang
- School of Population and Global HealthThe University of MelbourneVictoriaAustralia,School of Public HealthThe Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Don Eliseo Lucero‐Prisno
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Wanghong Xu
- School of Public HealthFudan UniversityShanghaiChina
| | - Zhi‐Jie Zheng
- Department of Global Health, School of Public HealthPeking UniversityBeijingChina
| | | | - Mellissa Withers
- Department of Population and Public Health Sciences, Institute for Global HealthUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina,School of Public HealthThe Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina,Department of Global Health, School of Public HealthPeking UniversityBeijingChina
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Haier J, Schaefers J. Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups. Cancers (Basel) 2022; 14:cancers14133158. [PMID: 35804928 PMCID: PMC9265013 DOI: 10.3390/cancers14133158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care. Abstract Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.
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Monsereenusorn C, Alcasabas AP, Loh AHP, Soh SY, Leung KWP, Kimpo M, Dhamne C, Blair S, Lam C, Photia A, Rujkijyanont P, Traivaree C, Pairojboriboon S, Rodriguez-Galindo C. Impact of treatment refusal and abandonment on survival outcomes in pediatric osteosarcoma in Southeast Asia: A multicenter study. Pediatr Blood Cancer 2022; 69:e29556. [PMID: 35038209 DOI: 10.1002/pbc.29556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment refusal and abandonment (TxRA) are major barriers to improving outcomes among children with sarcomas of the extremities as curative treatment options bearing on amputation or disfiguring surgery, particularly in countries with limited resources. A multi-institutional retrospective study was conducted to determine the predictive factors for TxRA among patients with osteosarcoma associated with survival outcomes across Southeast Asia (SEA). METHODS Pediatric patients with osteosarcoma treated between January 1998 and December 2017 in four SEA pediatric oncology centers from three countries were studied. Nelson-Aalen estimates, Kaplan-Meier method, and Cox's proportion hazard model were applied to address the cumulative incidence, survival outcomes, and to identify prognostic factors associated with TxRA. RESULTS From a total of 208 patients with osteosarcoma enrolled; 18 (8.7%) patients refused and 41 (19.7%) patients abandoned treatment. Income classification of countries, age at diagnosis, tumor size, disease extent, chemotherapy protocols, and types of surgery were associated with TxRA. Tumor size more than 15 cm was an independent risk factor associated with TxRA. The 5-year overall and relapse-free survivals were 49.4% and 50.4%, respectively. However, these rates declined further to 37.9% and 35.8%, respectively, when TxRA were considered as events. Tumor size larger than 15 cm and metastatic disease were independent risk factors associated with TxRA-sensitive outcomes. CONCLUSION The prevalence of TxRA was high in SEA, particularly in lower middle-income countries. Factors associated with TxRA related to tumor burden. Treatment outcomes could be substantially improved by lowering the refusal and abandonment rates.
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Affiliation(s)
- Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ana Patricia Alcasabas
- Section of Hematology-Oncology, Department of Pediatrics, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Amos Hong Pheng Loh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Shui Yen Soh
- Duke-NUS Medical School, Singapore.,Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | | | - Miriam Kimpo
- Division of Pediatric Hematology/Oncology & Bone Marrow and Cord Blood Transplantation, University Children's Medical Institute, National University Hospital, Singapore
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sally Blair
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Catherine Lam
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sutipat Pairojboriboon
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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30
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Mailankody S, Kumar VS, Khan SA, Banavali SD, Bajpai J. Resource-appropriate selection of osteosarcoma treatment protocols in low- and middle-income countries. Pediatr Blood Cancer 2022; 69:e29540. [PMID: 34971016 DOI: 10.1002/pbc.29540] [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: 02/02/2021] [Revised: 10/30/2021] [Accepted: 12/08/2021] [Indexed: 02/01/2023]
Abstract
Osteosarcoma is a rare malignancy; however, it is still the most common primary bone tumor in adolescents and young adults. Chemotherapy improves survival indubitably in osteosarcoma; nevertheless, the concern is the stagnant progress since the last several decades. There are a handful of active agents and unresolved issues, especially in choosing the ideal chemotherapy regimen. The oncology community is in equipoise regarding the position of high-dose methotrexate (HDMTX), mandatory or adjunct. The choice of therapy becomes widely relevant, including in low- and middle-income countries (LMIC), where HDMTX administration brings additional complexities. Research into novel non-HDMTX-based protocols adapted to the available resources is pivotal in improving disease outcomes, especially in LMIC. The current review focuses on real-world challenges in decision-making and provides a comprehensive overview of the evolution of treatment protocols in LMIC.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Karnataka, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Mumbai, Maharasthra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Mumbai, Maharasthra, India
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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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van Weelderen RE, Njuguna F, Klein K, Mostert S, Langat S, Vik TA, Olbara G, Kipng'etich M, Kaspers GJL. Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya. Cancer Rep (Hoboken) 2021; 5:e1576. [PMID: 34811958 PMCID: PMC9575503 DOI: 10.1002/cnr2.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.
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Affiliation(s)
- Romy E van Weelderen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kim Klein
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sandra Langat
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Terry A Vik
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gilbert Olbara
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Martha Kipng'etich
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Graetz DE, Rivas SE, Wang H, Vedaraju Y, Fuentes AL, Caceres-Serrano A, Antillon-Klussmann F, Devidas M, Metzger ML, Rodriguez-Galindo C, Mack JW. Communication Priorities and Experiences of Caregivers of Children With Cancer in Guatemala. JCO Glob Oncol 2021; 7:1529-1536. [PMID: 34748391 PMCID: PMC8577673 DOI: 10.1200/go.21.00232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although > 90% of children with cancer live in low- and middle-income countries, little is known about communication priorities and experiences of families in these settings. We examined communication priorities and the quality of information exchange for Guatemalan caregivers of children with cancer during diagnostic communication. METHODS A cross-sectional survey including items used in pediatric communication studies from high-income countries and novel questions was verbally administered to 100 caregivers of children with cancer in Guatemala. RESULTS Guatemalan caregivers prioritized communication functions of exchanging information (99%), fostering healing relationships (98%), decision making (97%), enabling self-management (96%), and managing uncertainty (94%) over responding to emotions (66%) and cultural awareness (48%). Almost all caregivers wanted as many details as possible about their child's diagnosis and treatment (96%), likelihood of cure (99%), and late effects (97%). Only 67% were always given the information they needed without asking for it, and most caregivers sometimes (56%) or always (18%) had questions they wanted to discuss but did not. Approximately half of the caregivers (54%) correctly identified their child's diagnosis, primary site, disease extent (localized v metastatic), proposed treatment length, and treatment intent (curative v palliative). Caregivers of children with leukemia were more likely to correctly identify all attributes than those whose children had solid tumors (P < .001). CONCLUSION Caregivers in Guatemala prioritize many of the same aspects of diagnostic communication as parents in the United States, and experience similar challenges. Shared communication values offer potential for adaptation of communication interventions across settings with varying resources and diverse cultures. Communication priorities and experiences of caregivers of children with cancer in Guatemala similar to those in US.![]()
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Affiliation(s)
| | | | - Huiqi Wang
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.,Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | | | | | | | - Jennifer W Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
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Atwiine B, Busingye I, Kyarisiima R, Baluku E, Mbabazi R, Bamwine B, Ankunda S, Libes J, Weinstein H, Schwartz K, Kiwanuka G. "Money was the problem": Caregivers' self-reported reasons for abandoning their children's cancer treatment in southwest Uganda. Pediatr Blood Cancer 2021; 68:e29311. [PMID: 34459106 DOI: 10.1002/pbc.29311] [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: 04/13/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Treatment abandonment contributes significantly to poor survival of children with cancer in low- and middle-income countries (LMIC). In order to inform an approach to this problem, we investigated why caregivers withdraw their children from treatment. METHODS In a qualitative study, carried out in October and November 2020, in-depth interviews were conducted with caregivers of children who had abandoned cancer treatment at the Pediatric Cancer Unit of Mbarara Regional Referral Hospital in south-western Uganda. Recorded in-depth interviews were transcribed and analyzed to identify themes of caregivers' self-reported reasons for treatment abandonment. The study was approved by the Review and Ethics Committee of Mbarara University of Science and Technology. RESULTS Seventy-seven out of 343 (22.4%) children diagnosed with cancer abandoned treatment during the study period; 20 contactable and consenting caregivers participated in the study. The median age of the caregivers was 37 years and most (65%) were mothers. At the time of this study, eight (40%) children were alive and five (62.5%) were males; with a median age of 6.5 years. Financial difficulty, other obligations, the child falsely appearing cured, preference for alternative treatments, belief that cancer was incurable, fear that the child's death was imminent and chemotherapy side effects were the caregivers' reasons for treatment abandonment. CONCLUSIONS AND RECOMMENDATION Seeking cancer treatment for children in Uganda is an expensive venture and treatment abandonment is mainly caused by caregivers' difficult socio-economic circumstances. This problem needs to be approached with empathy and support rather than blame.
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Affiliation(s)
- Barnabas Atwiine
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Imelda Busingye
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rose Kyarisiima
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Emmanuel Baluku
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Ruth Mbabazi
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Brian Bamwine
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Siyadora Ankunda
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Jaime Libes
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Howard Weinstein
- Division of Pediatric Hematology and Oncology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Kevin Schwartz
- Division of Pediatric Hematology and Oncology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Gertrude Kiwanuka
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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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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Haematological malignancies in sub-Saharan Africa: east Africa as an example for improving care. LANCET HAEMATOLOGY 2021; 8:e756-e769. [PMID: 34481552 DOI: 10.1016/s2352-3026(21)00198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
Haematological malignancies account for almost 10% of all cancers diagnosed in sub-Saharan Africa, although the exact incidences and treatment outcomes are difficult to discern because population-based cancer registries in the region are still underdeveloped. More research on haematological malignancies in sub-Saharan Africa is required to establish whether these cancers have a natural history similar to those diagnosed in high-income countries, about which more is known. Several factors negatively affect the outcome of haematological malignancies in sub-Saharan Africa, showcasing a need for improved understanding of the clinicobiological profile of these cancers to facilitate prevention, early detection, diagnosis, and appropriate treatment through increased capacity building, infrastructure, community awareness, coordinated resource mobilisation, and collaboration across the world. The east African governments have pooled resources for common investments to tackle non-communicable diseases, developing the East Africa's Centres of Excellence for Skills and Tertiary Education project funded by the African Development Bank, an initiative that could be replicated for the care of haematological malignancies in other countries in sub-Saharan Africa. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Sen A, Chakrabarti P, Baul SN, Talukder AK, Mandal PK, De R, Dutta S, Dolai TK. Challenges in Care of Children with Acute Leukemia in a Government Hospital in India: A Retrospective Analysis. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many children are forced to abandon therapy.
Objective We have explored reasons for treatment abandonment through this study.
Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were included. Patients >18 years of age, having any history of treatment of AL outside our institute, and/or patients with relapsed AL were excluded. The primary outcome of the study was treatment abandonment rate.
Results A total of 710 AL patients were included in the study, average distance traversed to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%, n = 351), followed by >10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%), bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping. Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%).
Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason for this high abandonment, despite good disease prognosis, is a relevant social and health issue, and needs further evaluation. The problems discussed in this study are relevant to lower-income families and areas where health care is not easily accessible. The government agencies, nongovernment organizations and society would need to work together to overcome these issues.
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Affiliation(s)
- Ankita Sen
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Prantar Chakrabarti
- Department of Haematology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Shuvra N. Baul
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Prakas K. Mandal
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Rajib De
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Shyamali Dutta
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Tuphan K. Dolai
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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Amayiri N, Bouffet E. Treatment abandonment and refusal among children with central nervous system tumors in Jordan. Pediatr Blood Cancer 2021; 68:e29054. [PMID: 34022111 DOI: 10.1002/pbc.29054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/24/2021] [Accepted: 03/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Treatment abandonment and refusal are reported to contribute significantly to poor survival of children with cancer in low- and middle-income countries. We aimed to assess this phenomenon among children diagnosed with central nervous system (CNS) tumors in Jordan. METHODS We retrospectively reviewed the medical charts of children <18 years diagnosed with CNS tumors (2010-2020). Patients who abandoned or refused part of treatment were reviewed for their clinical characteristics, social circumstances, and possible reasons. We excluded patients referred for second opinion, radiotherapy only, or who traveled abroad for treatment. RESULTS Four hundred seventy-three Jordanian children were identified; 12 families (2.5%) abandoned treatment, and 15 refused part of therapy (3%). Most patients were females (67%) and most had good or moderate performance status (89%). Most families (93%) lived within 2 hours from King Hussein Cancer Center. Most parents were university graduates (71%) and all fathers were employed, while 71% of mothers were housewives. The most common reasons to abandon or refuse therapy were treatment intensity in view of poor tumor outcome or bad quality of life, conflicting recommendations from other health care providers, "personal beliefs" against chemotherapy, and preference to use alternative medicine. CONCLUSIONS Treatment abandonment and refusal in Jordanian children with CNS tumors is low. Universal cancer insurance, high level of education in the country, centralized cancer care in one institution, and the twinning program likely contributed to our low incidence. Improving knowledge on CNS tumors and better community rehabilitation and supportive services may help further decrease the abandonment and treatment refusal rate.
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Affiliation(s)
- Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Graetz D, Rivas S, Fuentes L, Cáceres-Serrano A, Ferrara G, Antillon-Klussmann F, Metzger M, Rodriguez-Galindo C, Mack JW. The evolution of parents' beliefs about childhood cancer during diagnostic communication: a qualitative study in Guatemala. BMJ Glob Health 2021; 6:bmjgh-2020-004653. [PMID: 34039587 PMCID: PMC8160167 DOI: 10.1136/bmjgh-2020-004653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fatalistic cancer beliefs may contribute to delayed diagnosis and poor outcomes, including treatment abandonment, for children with cancer. This study explored Guatemalan parents' cancer beliefs during initial paediatric cancer communication, and the sociocultural and contextual factors that influence these beliefs. METHODS Twenty families of children with cancer were included in this study. We audio-recorded psychosocial conversations with psychologists and diagnostic conversations with oncologists, then conducted semi-structured interviews with parents to explore the evolution of their cancer beliefs. Audio-recordings were transcribed and translated from Spanish into English, with additional review in both languages by bilingual team members. All 60 transcripts were thematically analysed using a priori and novel codes. RESULTS Guatemalan parents' beliefs evolve as they learn about cancer through various sources. Sources of information external to the cancer centre, including prior experiences with cancer, media exposure, community discussion and clinical encounters, contribute to pre-existing beliefs. Many parents' pre-existing cancer beliefs are fatalistic; some are influenced by Mayan spirituality. Sources internal to the cancer centre include psychologists and oncologists, other providers, other patients and families. Psychologists acknowledge pre-existing beliefs and deliver cancer education using verbal explanations and hand-drawings. Oncologists provide diagnostic information and outline treatment plans. Both support hope by providing a path toward cure. Parents' lived experience is a culmination of sources and simultaneously independent. Ultimately most parents arrive at an understanding of cancer that is consistent with an allopathic medical model and offers optimism about outcomes. CONCLUSION An interdisciplinary communication process that includes cancer education, is attentive to pre-existing beliefs, and supports hope may encourage acceptance of the allopathic medical model and need for treatment. Providers in settings of all resource levels may be able to use these techniques to support cross-cultural cancer communication, reduce treatment abandonment and improve therapy adherence.
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Affiliation(s)
- Dylan Graetz
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Silvia Rivas
- Department of Palliative Care, Unidad Nacional de Oncologia Pediatrica, Guatemala, Guatemala
| | - Lucia Fuentes
- Department of Psychology, Unidad Nacional de Oncologia Pediatrica, Guatemala, Guatemala
| | - Ana Cáceres-Serrano
- Department of Psychology, Unidad Nacional de Oncologia Pediatrica, Guatemala, Guatemala
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Federico Antillon-Klussmann
- Department of Oncology, Universidad Francisco Marroquin Facultad de Medicina, Guatemala City, Guatemala.,Department of Oncology, Unidad Nacional de Oncologia Pediatrica, Guatemala, Guatemala
| | - Monika Metzger
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Departments of Pediatric Oncology and Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Medical Cost of Cancer Care for Privately Insured Children in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136746. [PMID: 34201571 PMCID: PMC8267683 DOI: 10.3390/ijerph18136746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.
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Das A, Achari RB, Zameer L, Sen S, Krishnan S, Bhattacharyya A. Treatment Refusal and Abandonment Remain Major Concerns Despite Good Outcomes with Multi-Modality Management in Pediatric Medulloblastoma: Experience from a Cancer Center in Eastern India. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_213_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Context: Survival in medulloblastoma, the most common pediatric brain tumor, has lagged behind in developing countries in comparison to the West. Aim: The aim of this study was to analyze the clinical profile and outcome in a cancer center in Eastern India. Methods: Twenty-nine children were retrospectively analyzed over 6 years. Results: Vomiting (79%), headache (69%), and unsteadiness (55%) were the presenting complaints. The majority (67%) had classical histology. High-risk (HR) disease (61.6%) exceeded average-risk (AR) (38.4%) disease in numbers. Treatment-refusal (27.6%) and abandonment (6.9%) were major concerns. Four-year EFS was 81% and 52%, excluding and including refusal/abandonment, respectively. There was no relapse/progression among AR patients. Four-year EFS in HR was 63%. Posterior fossa syndrome (37.5%), febrile neutropenia (29%), and ototoxicity (16.7%) were the main treatment-related morbidities. Implications: Following this audit, patient tracking to reduce abandonment, coordination to limit delay in postsurgical referral, developing strategies for molecular subgrouping, and reducing cumulative cisplatin exposure were measures adopted to improve outcome in the unit.
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Affiliation(s)
- Anirban Das
- Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Rimpa Basu Achari
- Departments of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Lateef Zameer
- Departments of Histopathology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Saugata Sen
- Departments of Radiology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Shekhar Krishnan
- Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Arpita Bhattacharyya
- Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
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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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Pritchard-Jones K, de C V Abib S, Esiashvili N, Kaspers GJL, Rosser J, Van Doorninck JA, Braganca JML, Hoffman RI, Rodriguez-Galindo C, Adams C, Connor SR, Abdelhafeez AH, Bouffet E, Howard SC, Challinor JM, Hessissen L, Dalvi RB, Kearns P, Chantada GL, Frazier LA, Sullivan MJ, Schulte FSM, Morrissey LK, Kozhaeva O, Luna-Fineman S, Khan MS. The threat of the COVID-19 pandemic on reversing global life-saving gains in the survival of childhood cancer: a call for collaborative action from SIOP, IPSO, PROS, WCC, CCI, St Jude Global, UICC and WHPCA. Ecancermedicalscience 2021; 15:1187. [PMID: 33777180 PMCID: PMC7987488 DOI: 10.3332/ecancer.2021.1187] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic poses an unprecedented health crisis in all socio-economic regions across the globe. While the pandemic has had a profound impact on access to and delivery of health care by all services, it has been particularly disruptive for the care of patients with life-threatening noncommunicable diseases (NCDs) such as the treatment of children and young people with cancer. The reduction in child mortality from preventable causes over the last 50 years has seen childhood cancer emerge as a major unmet health care need. Whilst survival rates of 85% have been achieved in high income countries, this has not yet been translated into similar outcomes for children with cancer in resource-limited settings where survival averages 30%. Launched in 2018, by the World Health Organization (WHO), the Global Initiative for Childhood Cancer (GICC) is a pivotal effort by the international community to achieve at least 60% survival for children with cancer by 2030. The WHO GICC is already making an impact in many countries but the disruption of cancer care during the COVID-19 pandemic threatens to set back this global effort to improve the outcome for children with cancer, wherever they may live. As representatives of the global community committed to fostering the goals of the GICC, we applaud the WHO response to the COVID-19 pandemic, in particular we support the WHO’s call to ensure the needs of patients with life threatening NCDs including cancer are not compromised during the pandemic. Here, as collaborative partners in the GICC, we highlight specific areas of focus that need to be addressed to ensure the immediate care of children and adolescents with cancer is not disrupted during the pandemic; and measures to sustain the development of cancer care so the long-term goals of the GICC are not lost during this global health crisis.
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Affiliation(s)
- Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1E, United Kingdom.,International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Simone de C V Abib
- Division of Pediatric Surgery, Pediatric Oncology Institute (GRAACC), Federal University of São Paulo, Rua Pedro de Toledo, 572, 04039-001 São Paulo, Brazil.,International Society of Paediatric Surgical Oncology (IPSO), Tienrayseweg 10, 5961NL Horst, The Netherlands
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, 1365 Clifton Road, NE, Atlanta, GA 30322, USA.,Paediatric Radiation Oncology Society (PROS), 28 rue Laennec, F-69373 Lyon, Cedex 08, France
| | - Gertjan J L Kaspers
- Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, NL-3584 CS Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.,World Child Cancer (WCC), The Netherlands, P.O. Box 113, 3720 AC Bilthoven, The Netherlands
| | - Jon Rosser
- World Child Cancer (WCC) UK, 9 Maltings Place, London SE1 3JB, UK
| | - John A Van Doorninck
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Rocky Mountain Hospital for Children, 2055 High Street, #340, Denver, CO 80211, USA.,World Child Cancer (WCC) USA, 1301 Arapahoe St Suite 105, Golden, CO 80401, USA
| | - João M L Braganca
- Childhood Cancer International (CCI), Kraijenhoffstraat 137A, 1018RG Amsterdam, The Netherlands
| | - Ruth I Hoffman
- Childhood Cancer International (CCI), Kraijenhoffstraat 137A, 1018RG Amsterdam, The Netherlands
| | - Carlos Rodriguez-Galindo
- Department of Global Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Cary Adams
- Union for International Cancer Control (UICC), 31-33 Avenue Giuseppe Motta, 1202 Geneva, Switzerland
| | - Stephen R Connor
- Worldwide Hospice Palliative Care Alliance (WHPCA), 10990 Rice Field Pl, Fairfax Station, VA 22039, USA
| | - Abdelhafeez H Abdelhafeez
- International Society of Paediatric Surgical Oncology (IPSO), Tienrayseweg 10, 5961NL Horst, The Netherlands.,Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Eric Bouffet
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Division of Haematology/Oncology, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, Canada
| | - Scott C Howard
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Julia M Challinor
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,School of Nursing, University of California San Francisco, 36 Rockview Dr., Santa Cruz, CA 95062, USA
| | - Laila Hessissen
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatric Hematology and Oncology, Children Hospital of Rabat, Mohamed V university of Rabat, Ibn Rochd avenue, Rabat 6542, Morocco
| | - Rashmi B Dalvi
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatrics and Pediatric Hematology Oncology, Bombay Hospital Institute of Medical sciences, street 20, New Marine lines, Mumbai 400020, India
| | - Pamela Kearns
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK.,European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Guillermo L Chantada
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Hematology-Oncology, Hospital Pereira Rossell-Fundacion Perez-Scremini (secondary: Hospital Sant Joan De Deu), Bulevar Artigas 1556, 11600 Montevideo, Uruguay
| | - Lindsay A Frazier
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA
| | - Michael J Sullivan
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Children's Cancer Centre and Department of Paediatrics, Royal Children's Hospital and University of Melbourne, 50 Flemington Road, Parkville 3052, Melbourne, Australia.,Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, 2202 2 St., T2S 3C3, Calgary, Canada.,Paedatric Psycho-Oncology (PPO) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Lisa K Morrissey
- Nursing and Patient Services, Division of Hematology/Oncology/HSCT, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,Nursing Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Olga Kozhaeva
- Policy Affairs, European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Sandra Luna-Fineman
- Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Division of Hematology/Oncology/SCT, Department of Pediatrics, Children's Hospital Colorado, U Colorado, 13123 E 16th Ave, B115, Aurora, CO 80045, USA
| | - Muhammad S Khan
- Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Pediatric Hematology and Oncology Division, Tawam Hospital, Al Ain (Abu Dhabi), PO Box 15258, United Arab Emirates
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Li W, Wang X, Yang Y, Zhao L, Lin D, Wang J, Zhu Y, Chen C, Liu Z, Wu X, Zhang X, Wang R, Li R, Ting DSW, Huang W, Lin H. The associations of population mobility in HIV disease severity and mortality rate in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:315. [PMID: 33708942 PMCID: PMC7944320 DOI: 10.21037/atm-20-4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Human immunodeficiency virus (HIV) infection has become a chronic disease and attracted public attention globally. Population migration was considered hindering the control and management of HIV infection, but limited studies have explored how population mobility could influence the development of HIV-related complications and overall prognosis. Methods We enrolled hospitalized HIV patients in this cross-sectional study between January 1, 2006, and December 31, 2016. We extracted demographic, hospitalization, and patient diagnosis data. Patients were divided into three groups according to the population type: (I) resident of Guangzhou City (local resident); (II) migrant outside of Guangzhou City but within Guangdong Province (migrant within the province); and (III) migrant outside of Guangdong Province (migrant outside the province). To represent the prognosis of HIV, in-hospital death was defined as the worst outcome, whereas vision-related events were considered moderate-to-severe complications. Logistic regression models were used to analyze factors influencing the prognosis of HIV. Results Eight thousand and six hundred thirty-one inpatients (14,954 cases) were enrolled. The overall mortality was 7.9%, decreasing from 21.5% in 2006 to 3.8% in 2016. The prevalence of vision-related events was 14.4% between 2015 and 2016. Compared to local patients, migrant patients (within and outside the province) were younger, had significantly less access to health insurance, fewer hospitalization admissions, longer hospital stays, and a higher proportion of physical work (P<0.01). Furthermore, they had a higher prevalence of vision-related events (16.2% and 17.4% in migrant patients within the province and outside the province, respectively vs. 9.5%) and infectious diseases, but lower in-hospital mortality (5.9% and 7.0% vs. 12.3%) than local patients. Migrants correlated negatively with in-hospital death [odds ratio (OR) 95% CI, 0.37 (0.29–0.48) and 0.52 (0.40–0.68)] but correlated positively with vision-related events [OR (95% CI), 2.08 (1.54–2.80) and 2.03 (1.47–2.80)]. Conclusions Migrant patients have significantly poorer access to health insurance, with an increased risk of developing moderate-to-severe HIV infection but a decreased risk of in-hospital death, indicating a trend toward withdrawing treatment in migrant patients when they have advanced diseases. Managements such as optimizing access to health insurance and improving follow-up visits for HIV infection should be considered in the context of the population mobility of HIV patients.
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Affiliation(s)
- Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
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Mattosinho C, Moura AT, Grigorovski N, Araújo LH, Ferman S, Ribeiro K. Socioeconomic status and retinoblastoma survival: Experience of a tertiary cancer center in Brazil. Pediatr Blood Cancer 2021; 68:e28757. [PMID: 33089657 DOI: 10.1002/pbc.28757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Little is known about socioeconomic status (SES) and its effects in childhood cancer survival. This study aims to discuss the association between SES and survival of patients with retinoblastoma (RB) from a tertiary treatment center. PROCEDURE A retrospective cohort study was conducted, including all patients with RB referred to the Brazilian National Institute of Cancer in Rio de Janeiro (January 2000-December 2016). RESULTS Data from 160 patients were analyzed with mean age at diagnosis of 22.85 months (SD ± 14.29). Eighty-three patients (51.9%) had an interval to diagnosis equal to or longer than six months, and 13 children (8.1%) abandoned treatment. Five-year overall survival rate for all patients was 78.8% (95% CI, 72.4%-85.9%). In a multivariate model, patients whose fathers had more than nine years of study had a lower death risk. Patients from families having more than one child under five years had a 213% higher risk of death compared with those living with no other small child. Treatment abandonment also had a profound effect on death risk. CONCLUSION Childhood cancer is notably important considering the potential years of life lost. RB has even more important elements, as the possibility of vision loss in cases with delayed diagnosis. Family characteristics seem to be highly related to RB survival, especially in low- and middle-income countries, where inequalities are still a public health issue. Strategies to improve survival should focus not only on large-scale settings such as improving national healthcare systems but also on more personalized actions that might help to mitigate disparities.
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Affiliation(s)
- Clarissa Mattosinho
- Department of Ocular Oncology, Division of Surgery, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Anna Tereza Moura
- Department of Pediatrics, Faculdade de Medicina, Pós Graduação em Ciências Médicas da Universidade do Estado do, Rio de Janeiro, Brazil
| | - Nathalia Grigorovski
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Luiz Henrique Araújo
- Division of Clinical Research, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Sima Ferman
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Karina Ribeiro
- Department of Collective Health (Associate Professor), Faculdade de Ciências Médicas da Santa Casa, São Paulo, Brazil
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Alecsa MS, Moscalu M, Trandafir LM, Ivanov AV, Rusu C, Miron IC. Outcomes in Pediatric Acute Lymphoblastic Leukemia-A Single-Center Romanian Experience. J Clin Med 2020; 9:jcm9124052. [PMID: 33333966 PMCID: PMC7765371 DOI: 10.3390/jcm9124052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study evaluates the main (para)clinical aspects and outcomes in a group of Romanian children diagnosed with acute lymphoblastic leukemia (ALL), under the conditions of antileukemic treatment according to an adapted ALL IC Berlin-Frankfurt-Munster (BFM) 2002 protocol. METHODS We performed a retrospective single-center study of 125 children diagnosed with ALL between 2010 and 2016. Standard forms were used for data collection of variate clinical and paraclinical parameters. RESULTS The children were predominantly male (64.8%) and their median age at diagnosis was 5 years. A total of 107 patients were diagnosed with precursor B-cell acute lymphoblastic leukemia (BCP)-ALL and 18 with T-cell acute lymphoblastic leukemia T-ALL. Multiplex reverse transcription polymerase chain reaction RT-PCR assay for ETV6-RUNX1, BCR-ABL, E2A-PBX1, KMT2A-AFF1, and STIL-TAL1 fusion genes was performed in 111 patients. ETV6-RUNX1 translocation was detected in 18.9% of patients, while BCR-ABL1 and E2A-PBX1 rearrangements were seen in 2.7% and 3.6%, respectively. Complete remission at the end of induction phase was obtained in 89.6% of patients. The overall relapse rate was 11.2%, with 11 early and 3 late relapses. The 5-year overall survival rate in BCP-ALL was 81.6% and in T-ALL 71.4%. CONCLUSIONS The 5-year overall and event-free survival rates in our study were slightly lower than those reported in developed countries, so the patients' outcomes are encouraging.
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Affiliation(s)
- Mirabela-Smaranda Alecsa
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Division of Informatics and Medical Statistics, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Laura-Mihaela Trandafir
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Anca-Viorica Ivanov
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Cristina Rusu
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Medical Genetics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith-Crenguta Miron
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
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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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Githang'a J, Brown B, Chitsike I, Schroeder K, Chekwenda-Makore N, Majahasi F, Ogundoyin O, Renner L, Petricca K, Denburg AE, Horton SE, Gupta S. The cost-effectiveness of treating childhood cancer in 4 centers across sub-Saharan Africa. Cancer 2020; 127:787-793. [PMID: 33108002 DOI: 10.1002/cncr.33280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost-effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub-Saharan Africa. METHODS Within hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost-effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy. RESULTS Cost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical personnel in the other 3 centers. The cost per disability-adjusted life-year averted ranged from 0.3 to 3.6 times the per capita gross national income. Childhood cancer treatment therefore was considered to be very cost-effective by World Health Organization standards in 2 countries and cost-effective in 1 additional country. In all centers, abandonment of treatment was common; modeling exercises suggested that public funding of treatment, additional psychosocial personnel, and modifications of inpatient policies would increase survival rates while maintaining or even improving cost-effectiveness. CONCLUSIONS Across various African countries, childhood cancer treatment units represent cost-effective interventions. Cost-effectiveness can be increased through the control of drug prices, appropriate policy environments, and decreasing the rate of treatment abandonment. These results will inform national childhood cancer strategies across Africa.
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Affiliation(s)
- Jessie Githang'a
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
| | - Biobele Brown
- Department of Paediatrics, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Inam Chitsike
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kristin Schroeder
- Department of Pediatrics and Global Health, Duke University School of Medicine, Durham, North Carolina
| | - Nester Chekwenda-Makore
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Olakayode Ogundoyin
- Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Lorna Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Kadia Petricca
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram E Denburg
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sue E Horton
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sumit Gupta
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Barr RD. The challenges of delivering cost-effective and affordable care to children with cancer in the developing world. Cancer 2020; 127:676-678. [PMID: 33107984 DOI: 10.1002/cncr.33279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022]
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Abstract
BACKGROUND Infections in children treated for cancer contribute to morbidity and mortality. There is a paucity of studies on the incidence, etiology, risk factors and outcome of bacterial infections in African children treated for cancer. The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in children with cancer. METHODS The study enrolled children 1-19 years old with cancer and infections. Children were investigated for infection as part of standard of care. RESULTS One hundred sixty-nine children were enrolled, 82 with hematologic malignancies and 87 with solid tumors and 10.7% were HIV infected. The incidence (per 100 child-years) of septic episodes (101) microbiologically confirmed (70.9) septic episodes, Gram-positive (48.5) and Gram-negative (37.6) sepsis was higher in children with hematologic malignancies than in those with solid tumors. The most common Gram-positive bacteria were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium, while the most common Gram-negative bacteria were Escherichia coli, Acinetobacter baumannii and Pseudomonas species. The C-reactive protein and procalcitonin was higher in microbiologically confirmed sepsis. The case fatality risk was 40.4%; 80% attributed to sepsis. The odds of dying from sepsis were higher in children with profound [adjusted odds ratio (aOR) = 3.96; P = 0.004] or prolonged neutropenia (aOR = 3.71; P = 0.011) and profound lymphopenia (aOR = 4.09; P = 0.003) and independently associated with pneumonia (53.85% vs. 29.23%; aOR = 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR = 4.3; P = 0.005). CONCLUSION The study emphasizes the high burden of sepsis in African children treated for cancer and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.
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