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Wijnen N, Klootwijk L, Gichemi A, Apadet L, Njuguna F, Klein K, Huibers M, Goemans BF, Mostert S, Kaspers G. Childhood cancer care beyond the 'six common and curable types': A comparative case series on acute myeloid leukemia in Kenya and the Netherlands. Asia Pac J Oncol Nurs 2024; 11:100565. [PMID: 39380686 PMCID: PMC11458545 DOI: 10.1016/j.apjon.2024.100565] [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: 06/18/2024] [Accepted: 07/29/2024] [Indexed: 10/10/2024] Open
Abstract
Annually, over 400,000 children develop cancer, with the majority living in low- and middle-income countries (LMICs). Survival rates in high-income countries (HICs; ≥ 75%-80%) significantly exceed those in LMICs (< 30%). Acute myeloid leukemia (AML) is a childhood cancer with high mortality rates in LMICs and is not included in the World Health Organization (WHO)'s 'six common and curable types of cancer'. This case report explores two pediatric AML cases in Kenya (LMIC) and the Netherlands (HIC), highlighting differences and similarities in both patient journeys. The first case is a 15-year-old Kenyan boy who initially experienced dizziness and fatigue. After repeated blood transfusions without a definitive diagnosis, AML was confirmed via bone marrow aspiration (BMA) 63 days later, and treatment followed the SIOP PODC AML guidelines for LMICs. The second case is a 6-year-old Dutch boy with fatigue and malaise. Initially diagnosed with post-viral bone marrow failure, a BMA performed 61 days after symptom onset revealed AML, and treatment followed the NOPHO-DBH AML-2012 protocol. Both patients faced frequent febrile neutropenia, managed per local guidelines, illustrating the balance between anti-cancer treatment and supportive care. Despite challenges, both boys completed treatment and are in complete remission. This case series highlights the potential for effective AML treatment in resource-constrained settings and underscores the need to address cancers beyond the 'six common and curable types'.
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Affiliation(s)
- Noa Wijnen
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Larissa Klootwijk
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Alice Gichemi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Lilian Apadet
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Kim Klein
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Minke Huibers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Bianca F. Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gertjan Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Olbara G, Njuguna F, Etling MA, Langat S, Kipng'etich M, Nessle CN, Kaspers GJL, Vik TA, Severance TS. Clinical Impact of Project ECHO in Children With Cancer in Western Kenya: A Case Series. JCO Glob Oncol 2024; 10:e2400279. [PMID: 39208377 DOI: 10.1200/go-24-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Mary Ann Etling
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | - Sandra Langat
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Charles N Nessle
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
- Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Terry A Vik
- Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Klootwijk L, Osamong LA, Langat S, Njuguna F, Kimaiyo S, Vik TA, Kaspers G, Mostert S. Childhood Cancer Awareness Program in Bungoma County, Kenya. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02468-z. [PMID: 38907906 DOI: 10.1007/s13187-024-02468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Awareness could play a key role in reducing underdiagnosis and accelerating referral of childhood cancer in low- and middle-income countries and ultimately improve outcomes. This study describes the implementation of a childhood cancer awareness program in Bungoma County in Kenya, containing five components: (1) baseline data collection of primary healthcare facilities; (2) live training session for healthcare providers (HCP); (3) early warning signs posters; (4) online SMS course for HCP; and (5) radio campaign. METHODS This study was conducted between January and June 2023. All 144 primary healthcare facilities (level 2 and 3 health facilities) within Bungoma County were visited by the field team. RESULTS All 125 level 2 (87%) and 19 level 3 (13%) facilities participated in the study. National Health Insurance Fund (NHIF) failed to cover services in 37 (26%) facilities. HCP were more often reported absent at level 3 (89%) than level 2 (64%) facilities (P = 0.034). The 144 live training sessions were attended by over 2000 HCP. Distribution of 144 early warning signs posters resulted in 50 phone calls about suspected childhood cancer cases. Sixteen children were later confirmed with childhood cancer and treated. Online SMS learning was completed by 890 HCP. Knowledge mean scores improved between pre-test (7.1) and post-test (8.1; P < 0.001). Finally, 540 radio messages about childhood cancer and a live question-and-answer session were broadcasted. CONCLUSION This study described the implementation of a childhood cancer awareness program in Kenya involving both HCP and the general public. The program improved HCP's knowledge and increased the number of referrals for children with cancer.
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Affiliation(s)
- Larissa Klootwijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | | | - Sandra Langat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Sally Kimaiyo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Saskia Mostert
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Wang J, Zhen X, Coyte PC, Shao D, Zhao N, Chang L, Feng Y, Sun X. Association Between Online Health Information-Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China. J Med Internet Res 2023; 25:e46953. [PMID: 37585244 PMCID: PMC10468701 DOI: 10.2196/46953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information-seeking (OHIS) behaviors by caregivers. OBJECTIVE This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. METHODS This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. RESULTS A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. CONCLUSIONS Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact.
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Affiliation(s)
- Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Ni Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Lele Chang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
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Sampagar A, Keerthana S, Dias MC, Reddy NA, Patil N. A Study of Factors Influencing Delayed Diagnosis in Pediatric Cancers: A Step Towards Better Outcomes-A Cross-sectional Study. J Pediatr Hematol Oncol 2023; 45:327-332. [PMID: 37027235 DOI: 10.1097/mph.0000000000002664] [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: 11/05/2022] [Accepted: 02/18/2023] [Indexed: 04/08/2023]
Abstract
Annually, India contributes to one-fifth of newly diagnosed pediatric cancers worldwide. Poor outcome in India as compared with developed nations is mainly attributed to delayed diagnosis and study of factors influencing delay in diagnosis holds paramount importance in formulating strategies and counter-measures to improve survival. It was a cross-sectional study conducted on children diagnosed with malignancy at a tertiary care hospital. Diagnosis delay was defined and further divided into patient delay and physician delay. Various patient-related factors and socioeconomic factors that could affect diagnosis were studied. Statistical analysis included descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and multivariate linear regression. Of 185 patients enrolled, median diagnosis delay, patient delay, and physician delays were 59, 30, and 7 days respectively. Median diagnosis delay was significantly higher in younger children, children of illiterate parents, and low income. Median diagnosis delay in children presenting to a general practitioner (9 [4 to 29] days) was higher than those presenting to a pediatrician (5.5 [2 to 18] days). Sex, occupation of parents, and distance from oncology center did not affect time for diagnosis. We concluded that augmentation of the parent's attitudes, increased awareness, and decentralization of specialized pediatric care to rural areas can significantly reduce mortality from, otherwise, curable malignancies.
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Affiliation(s)
| | - Sarapu Keerthana
- Department of Pediatrics, KAHER Jawaharlal Nehru Medical College, Belagavi
| | - Merle Casia Dias
- Department of Pediatrics, KAHER Jawaharlal Nehru Medical College, Belagavi
| | | | - Neha Patil
- Department of Pediatrics, KAHER Jawaharlal Nehru Medical College, Belagavi
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Majaliwa E, Smith ER, Cotache-Condor C, Rice H, Gwanika Y, Canick J, Chao N, Schroeder K, Rice HE, Staton C, Mmbaga BT. Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study. JCO Glob Oncol 2023; 9:e2200263. [PMID: 37384861 PMCID: PMC10497254 DOI: 10.1200/go.22.00263] [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: 08/08/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
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Affiliation(s)
- Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hannah Rice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yotham Gwanika
- Kilimanjaro Cancer Registry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julia Canick
- Duke Global Health Institute, Duke University, Durham, NC
| | - Nelson Chao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Gardie Y, Wassie M, Wodajo S, Giza M, Ayalew M, Sewale Y, Feleke Z, Dessie MT. Delay in diagnosis and associated factors among children with cancer admitted at pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia: a retrospective cross-sectional study. BMC Cancer 2023; 23:469. [PMID: 37217881 DOI: 10.1186/s12885-023-10873-8] [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: 11/18/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022. METHOD Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis. RESULTS From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08-3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21-4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29-13.02), no referral (AOR = 6.3; 95%CI = 2.15-18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17-3.94) were significant factors associated with delay in diagnosis. CONCLUSION AND RECOMMENDATION Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child's residency, health insurance, type of cancer and comorbid disease. Thus; every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral.
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Affiliation(s)
- Yimenu Gardie
- Department of Nursing, College of health sciences, Assosa University, Assosa, Ethiopia.
| | - Mulugeta Wassie
- Department of medical nursing, School of Nursing, College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seid Wodajo
- Department of Midwifery, College of health sciences, Assosa University, Assosa, Ethiopia
| | - Mastewal Giza
- Department of public health, College of health sciences, Woldia University, Woldia, Ethiopia
| | - Mulugeta Ayalew
- Department of Pediatrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Yihenew Sewale
- Department of nursing, College of health sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Zelalem Feleke
- Department of Midwifery, College of health sciences, Assosa University, Assosa, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of pediatrics and child health nursing, School of Nursing, College of Health Sciences, University of Gondar, Gondar, Ethiopia
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Sari NM, Devansyah S, Modjaningrat I, Suryawan N, Susanah S, Rakhmillah L, Wahyudi K, Kaspers GJL. Type of cancer and complementary and alternative medicine are determinant factors for the patient delay experienced by children with cancer: A study in West Java, Indonesia. Pediatr Blood Cancer 2023; 70:e30192. [PMID: 36636790 DOI: 10.1002/pbc.30192] [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: 04/25/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice-associated risk factor to patient delay. METHODS This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi-structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. RESULTS We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6-46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14-126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79-9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13-3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health-seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. CONCLUSION Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.
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Affiliation(s)
- Nur Melani Sari
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Sultan Devansyah
- Universitas Padjadjaran, Faculty of Medicine, Bandung, Indonesia
| | | | - Nur Suryawan
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Susi Susanah
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Lulu Rakhmillah
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Kurnia Wahyudi
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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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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de Mattos CX, da Silva LF, Braga TRL, Bubadué RDM, Partelli ANM, Cabral IE. Family caregivers' itineraries of preschool children who survived leukemia: implications for primary healthcare nursing. Rev Bras Enferm 2023; 76:e20220193. [PMID: 36753256 PMCID: PMC9901353 DOI: 10.1590/0034-7167-2022-0193] [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: 06/01/2022] [Accepted: 10/01/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES to analyze the path taken by family caregivers of preschool children who survived leukemia and discuss the implications for primary healthcare nursing. METHODS the narrative interview guided by a talking map and body knowledge was used with family members of children who survived leukemia, living in Rio de Janeiro (capital) and São Paulo (countryside). Conversation analysis was applied to the data. RESULTS five family groups (seven people) of five children started their journey in the professional subsystem of private services; four were assisted in the private sector since the onset of the illness; one was assisted in public and private services. Living conditions reduced barriers to accessing supplementary health, facilitating coordination, and listening to a reference professional. FINAL CONSIDERATIONS the itinerary was marked by attentive listening to family caregivers by reference professionals, favoring early diagnosis, initiation of treatment, and resolution of leukemia with the cure of children.
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Hailu A, Mekasha A, Hailu D, Fentie AM, Korones DN, Gidey AM. Impact of Delay Prior to Treatment in Ethiopian Children with Acute Lymphoblastic Leukemia. Pediatric Health Med Ther 2023; 14:147-157. [PMID: 37197228 PMCID: PMC10184856 DOI: 10.2147/phmt.s406181] [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: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction More than 85% of childhood malignancies occur in developing countries with less than a 30% cure rate as opposed to more than 80% cure rate in developed countries. This disproportionately significant difference might be due to delays in diagnosis, treatment initiation, lack of adequate supportive care, and treatment abandonment. We aimed to determine the impact of overall treatment delay on induction mortality of children with acute lymphoblastic leukemia treated at Tikur Anbessa specialized hospital (TASH). Methods A cross-sectional study was conducted among children who were treated from 2016 to 2019. Children with Down syndrome and relapsed leukemia were excluded from this study. Results A total of 166 children were included; most patients were males (71.7%). The mean age at diagnosis was 5.9 years. The median time interval from the onset of symptoms to the first TASH visit was 30 days and the median period from TASH's first clinic visit to diagnosis was 11 days. The median time to initiate chemotherapy after diagnosis was 8 days. The total median time from the first onset of symptoms to chemotherapy initiation was 53.5 days. Induction mortality was 31.3%. High-risk ALL and patients with an overall delay between 30 and 90 days were more likely to experience induction mortality. Discussion Patient and healthcare system delay is high compared to most studies done and a significant association has been noted with induction mortality. Efforts to expand the pediatric oncology service in the country and efficient diagnostic and treatment approach need to be established to reduce mortality associated with overall delay.
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Affiliation(s)
- Abel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
- Correspondence: Abel Hailu, Email
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - David N Korones
- Department of Pediatrics, University of Rochester, New York, NY, USA
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12
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Mattos CXD, Silva LFD, Braga TRL, Bubadué RDM, Partelli ANM, Cabral IE. Itinerário de familiares cuidadores de pré-escolares sobreviventes de leucemia: implicações para enfermagem da atenção primária. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0193pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Objetivos: analisar o itinerário percorrido por familiares cuidadores de crianças pré-escolares sobreviventes da leucemia e discutir as implicações para enfermagem da atenção primária. Métodos: empregou-se a entrevista narrativa orientada pelo mapa falante e corpo saber com familiares de crianças sobreviventes de leucemia, residentes no Rio de Janeiro (capital) e São Paulo (interior). Aplicou-se a análise de conversação aos dados. Resultados: cinco núcleos familiares (sete pessoas) de cinco crianças iniciaram seu itinerário no subsistema profissional dos serviços privados; quatro foram assistidas no setor privado desde o início do adoecimento; uma foi assistida em serviços público e privado. As condições de vida reduziram barreiras de acesso à saúde suplementar, facilitando a coordenação e a escuta de um profissional de referência. Considerações Finais: o itinerário foi marcado por escuta atenta de familiares cuidadores pelo profissional de referência, favorecendo o diagnóstico precoce, início do tratamento e resolutividade da leucemia com a cura da criança.
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13
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Severance TS, Njuguna F, Olbara G, Kugo M, Langat S, Mostert S, Klootwijk L, Skiles J, Coven SL, Overholt KM, Kaspers G, Vik TA. An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Pediatr Blood Cancer 2022; 69:e29768. [PMID: 35593641 DOI: 10.1002/pbc.29768] [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: 12/17/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Western Kenya is home to approximately 24 million people, with 10 million children under the age of 15 years.1 Based on estimates of cancer incidence in similar populations from around the world, approximately 1500 patients should be diagnosed with pediatric cancer each year. This article describes the international collaboration that investigates potential barriers preventing the effective diagnosis of pediatric patients with cancer. METHODS Here, we describe a multidisciplinary and sequential approach to better evaluate the complex factors affecting the lack of appropriate diagnosis of pediatric cancer in Western Kenya. RESULTS Internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75%-80% of patients go undiagnosed and do not receive treatment. Following our screening process at a local referring hospital, 41 malaria slides demonstrated both morphologic and genetic evidence of leukemia. Knowledge assessments of local providers at referring institutions suggested a lack of education and training as the factors that contribute to lower rates of diagnosis. DISCUSSION Through a multi-step approach, our teams were better able to isolate potential issues impeding the appropriate and timely diagnosis of pediatric cancer in Kenya.
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Affiliation(s)
- Tyler S Severance
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | | | | | - Maureen Kugo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Saskia Mostert
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Larissa Klootwijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jodi Skiles
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Scott L Coven
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Kathleen M Overholt
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
| | - Terry A Vik
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA.,Moi Teaching and Referral Hospital, Eldoret, Kenya
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14
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Fowokan A, Afungchwi GM, Renner L, Freccero P, Gupta S, Denburg A. Evaluation of a Health Care Worker Training Intervention to Improve the Early Diagnosis and Referral of Childhood Cancers in Ghana: A Qualitative Descriptive Study. JCO Glob Oncol 2022; 8:e2200151. [PMID: 36103639 PMCID: PMC9812462 DOI: 10.1200/go.22.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS We identified six themes-affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement-that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.
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Affiliation(s)
- Adeleke Fowokan
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lorna Renner
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - Sumit Gupta
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Avram Denburg
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada,Avram Denburg, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8 Canada; e-mail:
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15
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Ding L, Szymczak JE, Evans E, Canepa E, Martin AE, Contractor F, Aplenc R, Joseph G, Winestone LE. Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study. BMC Cancer 2022; 22:531. [PMID: 35550034 PMCID: PMC9095817 DOI: 10.1186/s12885-022-09547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis. METHODS This qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family's experiences preceding the patient's diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data. RESULTS Thirty-two interviews were conducted with a diverse population of English and Spanish speaking participants from two tertiary care pediatric cancer centers. Parents reported feeling frustrated when their intuition conflicted with providers' management decisions. Many felt laboratory testing was not performed soon enough. Additional contributors to delays included misattribution of vague symptoms to more common diagnoses, difficulties in obtaining appointments, and financial disincentives to seek urgent or emergent care. Reports of difficulty obtaining timely appointments and financial concerns were disproportionately raised among low-income Black and Hispanic participants. Comparatively, parents with prior healthcare experiences felt better able to navigate the system and advocate for additional testing at symptom onset. CONCLUSIONS While there are disease-related factors contributing to delays in diagnosis, it is important to recognize there are multiple non-disease-related factors that also contribute to delays. Evidence-based approaches to reduce outcome disparities in pediatric cancer likely need to start in the primary care setting where timeliness of diagnosis can be addressed.
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Affiliation(s)
- Lucky Ding
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Julia E. Szymczak
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Erica Evans
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Emma Canepa
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Ashley E. Martin
- grid.239552.a0000 0001 0680 8770Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Farah Contractor
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Richard Aplenc
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Galen Joseph
- grid.266102.10000 0001 2297 6811Department of Humanities and Social Sciences, UCSF, San Francisco, CA USA ,grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA
| | - Lena E. Winestone
- grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA ,Division of Allergy, Immunology & BMT, UCSF Benioff Children’s Hospitals, Mail Stop 0434, 550 16th St, 4th Floor, San Francisco, CA USA
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16
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Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder K, Staton CA, Majaliwa E, Rice HE, Smith ER. Factors contributing to delayed childhood cancer care in low- and middle-income countries: A systematic review protocol. Pediatr Blood Cancer 2022; 69:e29646. [PMID: 35253351 PMCID: PMC11456978 DOI: 10.1002/pbc.29646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Significant disparities exist for timely access to cancer care for children, with the highest disparities in low- and middle-income countries (LMICs). This study aims to conduct a systematic review that identifies the factors contributing to delayed care of childhood cancers in LMICs. METHODS We will conduct a systematic review with search strings compliant with the PICO framework: (1) the Population-children (aged 0-18 years) from LMICs; (2) the Exposure-factors contributing to timely childhood cancer care; (3) the Outcome-delays in childhood cancer care. DISCUSSION Our study is an essential step to guide strategic interventions to assess the myriad of factors that prevent children from accessing timely cancer care in LMICs. The results will be submitted for publication in a peer-reviewed journal and shared with institutions related to the field.
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Affiliation(s)
| | - Andie Grimm
- Birmingham’s Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama
| | | | | | - Kelsey Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
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Joseph A, Balogun O, Akinsete A, Habeebu M, Jimoh M, Lasebikan N, Oyeyinka K, Akindele K, Awofeso O. Early detection of paediatric cancer: Equipping primary health-care workers in Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Mullen CJR, Barr RD, Franco EL. Timeliness of diagnosis and treatment: the challenge of childhood cancers. Br J Cancer 2021; 125:1612-1620. [PMID: 34471259 PMCID: PMC8651632 DOI: 10.1038/s41416-021-01533-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation 'delay in diagnosis and treatment' is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum.
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Affiliation(s)
- Callum J R Mullen
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada.
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19
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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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21
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Martins T, Merriel SWD, Hamilton W. Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review. BMJ Open 2020; 10:e038605. [PMID: 33444186 PMCID: PMC7678384 DOI: 10.1136/bmjopen-2020-038605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/02/2020] [Accepted: 10/17/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients' journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA. DESIGN AND SETTINGS A systematic review of available literature was performed. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject. RESULTS 18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi's sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi's sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region. CONCLUSION The proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - William Hamilton
- College of Medicine and Health, University of Exeter, Exeter, UK
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22
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Katumba RGN, Sensoy Bahar O, Johnson KJ, Ssewamala FM. Cancer in Youth Living With HIV (YLWHIV): A Narrative Review of the Access to Oncological Services Among YLWHIV and the Role of Economic Strengthening in Child Health. Front Public Health 2020; 8:409. [PMID: 32923421 PMCID: PMC7457003 DOI: 10.3389/fpubh.2020.00409] [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: 01/14/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Youth Living with HIV/AIDS (YLWHIV) have a higher risk of developing immunodeficiency related illnesses including certain cancers than their general population counterparts of the same age. This narrative review of current available literature describes factors associated with pediatric access to oncological services, and the role economic strengthening could play in improving health outcomes for this vulnerable population. Findings suggest that both HIV-infected and -uninfected children living in low and middle-income countries struggle with access and adherence to cancer treatment and care. Cost of treatment is a major barrier to access and adherence. Asset-building savings programs may increase financial security and subsequently result in better health outcomes although they have not been utilized to improve access to cancer treatment.
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Affiliation(s)
- Ruth G N Katumba
- School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Kimberly J Johnson
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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23
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Barragán-Pérez EJ, Altamirano-Vergara CE, Alvarez-Amado DE, García-Beristain JC, Chico-Ponce-de-León F, González-Carranza V, Juárez-Villegas L, Murata C. The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis. Pathol Oncol Res 2020; 26:2693-2701. [PMID: 32661835 DOI: 10.1007/s12253-020-00875-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.
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Affiliation(s)
| | | | - Daniel Eduardo Alvarez-Amado
- Pediatric Neurology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico. .,Hospital Infantil de México Federico Gómez, Calle Doctor Márquez 162, Alcadía Doctores, Cuauhtémoc, 06720, Ciudad de México, Mexico.
| | | | | | | | - Luis Juárez-Villegas
- Pediatric Oncology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional de Pediatria, Mexico City, Mexico
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Soares Martins QC, Gomes de Morais Fernandes FC, Pereira Santos VE, Guerra Azevedo I, Góes de Carvalho Nascimento LS, Dos Santos Xavier CC, Alves Pereira S. Factors Associated with the Detection of Childhood and Adolescent Cancer in Primary Health Care: A Prospective Cross-Sectional Study. J Multidiscip Healthc 2020; 13:329-337. [PMID: 32280234 PMCID: PMC7125305 DOI: 10.2147/jmdh.s225641] [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: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background The treatment of childhood cancer has achieved important advances evidencing a significant increase in overall survival; however, the diagnosis of these cases still seems late. Among the main causes for the delay in diagnosis are the issues related to the health system and the first professional who performs the care. The objective of this study is to evaluate the knowledge of primary care physicians and nurses about the most common signs and symptoms of pediatric cancers, as well as the factors related to the obtained scores. Methods This is a prospective cross-sectional study, developed in municipalities in the northeastern region of Brazil. Fifty-one professionals (physicians and nurses) were interviewed through a questionnaire structured as a quiz game about knowledge, training and attitudes regarding the signs and symptoms of childhood cancer. Multiple linear regression analysis was used to evaluate the effect of professional characteristics on the number of correct answers on the implemented questionnaire on knowledge of childhood and adolescent cancer. Results In the bivariate analysis, the results indicated that the type of employment relationship influences the number of correct answers in the questionnaire used. However, when adjusted for covariates, only the professional category, which means being a medical professional, showed a significant effect on the number of correct answers (β=-7.50, p=0.001). Conclusion The type of employment relationship of medical professionals and nurses working in primary care had an influence on the number of correct answers for knowledge of childhood and adolescent cancer, but only the professional category (physician) was associated with the highest number when controlled by covariables, thereby justifying the need to improve the curricular training of nurses and greater investments in primary health care for continuing health education that includes infant and adolescent oncology.
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Affiliation(s)
- Quenia Camille Soares Martins
- Federal University of Rio Grande do Norte, UFRN, Natal, Brazil.,Ana Bezerra University Hospital, Federal University of Rio Grande do Norte, UFRN, Natal, Brazil
| | | | | | - Ingrid Guerra Azevedo
- Ana Bezerra University Hospital, Federal University of Rio Grande do Norte, UFRN, Natal, Brazil.,Departamento de Recursos Terapeuticos, Universidad Católica de Temuco, Temuco, La Araucania, Chile
| | | | | | - Silvana Alves Pereira
- Federal University of Rio Grande do Norte, UFRN, Natal, Brazil.,Public Health Program of the Federal University of Rio Grande do Norte, FACISA/UFRN, Natal, Brazil
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Janic A, Kimani K, Olembo I, Dimaras H. Lessons for Patient Engagement in Research in Low- and Middle-Income Countries. Ophthalmol Ther 2020; 9:221-229. [PMID: 32222906 PMCID: PMC7196100 DOI: 10.1007/s40123-020-00246-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Patient engagement in research is marked by partnership between clinicians, scientists, and people with lived experience of a disease, who jointly develop and implement research and disseminate results. Patient engagement in research has been shown to lead to more impactful and relevant findings. There is a global need for quality research contextualized for low- and middle-income countries (LMICs). Patient involvement in research could address this need, yet it remains a practice more commonly employed in high income countries. In this paper, the authors explore LMIC-specific challenges and opportunities for patient engagement in research. Limitations to patient engagement in research include gaps in health infrastructure, socioeconomic status, cultural stigma, and uncertain roles. Potential solutions to address these challenges include strategic national and international research partnerships, initiatives to combat stigma, and sensitization and training of stakeholders in patient engagement in research. Reflecting on their patient engagement experience with eye cancer research in Canada and Kenya, and supported by evidence of patient engagement in other low-resource settings, the authors provide a roadmap for patient engagement in research in LMICs.
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Affiliation(s)
- Ana Janic
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Isabel Olembo
- Syndications and Agency Operations Department, Eastern and Southern African Trade and Development Bank, Nairobi, Kenya
| | - Helen Dimaras
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada. .,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Public Health, University of Toronto, Toronto, ON, Canada.
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Challinor JM, Day SW, Afungchwi GM, Alqudimat MR. Pediatric Oncology Nursing Research in Low- and Middle-Income Countries. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Pediatr 2019; 19:478. [PMID: 31810453 PMCID: PMC6896776 DOI: 10.1186/s12887-019-1848-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. The delays in cancer diagnosis may occur throughout the diagnostic pathway. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. The aim of this study was to identify determinants of delayed diagnosis among pediatric cancer patients in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Method Facility based cross-sectional study was conducted among pediatric cancer patients aged less than 18 years. Data collection was done by interviewer-administered structured questionnaire from the volunteer primary caregiver from 1st September 2017 to 30th August 2018. The data was checked and cleaned by principal investigator on daily basis during data collection for completeness, consistencies, then coded, entered and analyzed using SPSS version 21 software. Diagnosis delay was considered significant when it is above the 3rd quartile. Binary logistic regression analysis was used to test associations between each of the determinant factors and the dependent variable. Variables with P-value < 0.25 during bivariate analysis were fed to the multivariate logistic regression model. Finally, variables with P-value < 0.05 were considered as determinants of delayed diagnosis. Results From a total of 102 patients, 71(69.6%) had delayed diagnosis. Children older than 10 years of age were four (AOR = 4.01; 95%CI = 1.55–12, P < 0.001) times more likely to get delayed compared to under five children. Rural residence (AOR = 3.3; 95%CI = 1.24–10.24, P < 0.001), uneducated parents (AOR = 3.4; 95%CI = 1.91–13.25, P = 0.009), parents with monthly income less than 1000 ETB (AOR = 6.1; 95%CI = 1.76–7.23, P < 0.001), absence of health insurance (AOR = 2.4; 95%CI = 1.50–3.50, P = 0.02), visit to holy water (AOR = 3.4;95%CI = 1.6–7.2) and those who think cancer is incurable (AOR = 2.7;95%CI = 1.3–14,P = 0.004) were also likely to be delayed. Conclusion Delayed diagnosis of childhood cancer was a major issue and most influenced by the child’s age, residency, family’s socioeconomic status, parental education, health insurance, use of holy water and caregivers perception on curability of cancer. Thus; every effort should be made to promote public and parental awareness of childhood cancer and promoting health insurance.
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Affiliation(s)
- Alemseged Berhane
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Tadele Hailu
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- School of Public Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Ssewamala FM, Sensoy Bahar O, Johnson KJ, Katumba RG. Suubi4Cancer: A protocol for an innovative combination intervention to improve access to pediatric cancer services and treatment adherence among children living with HIV/AIDS in Uganda. Contemp Clin Trials Commun 2019; 16:100459. [PMID: 31650077 PMCID: PMC6804585 DOI: 10.1016/j.conctc.2019.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/19/2019] [Accepted: 09/28/2019] [Indexed: 12/03/2022] Open
Abstract
Youth Living with HIV (YLWHIV) are at high risk for cancer. Sub-Saharan Africa (SSA) has some of the worst pediatric cancer survival rates due to barriers to accessing cancer services and treatment adherence. This protocol describes a study that aims at: 1) Identifying confirmed and suspected cancer cases in a cohort of >3000 HIV positive youth; 2) Examining the short-term preliminary outcomes of an evidence-based Economic Empowerment (EE) intervention, Suubi ("hope" in a local Ugandan language), on access to pediatric cancer diagnosis and care, and treatment adherence among YLWHIV with suspected cancers in Uganda; and 3) Exploring multi-level factors impacting intervention participation and experiences. The proposed Suubi4Cancer intervention combines savings-led EE through family development accounts (FDA) with financial literacy and management (FLM) and cancer education (CE). The study will review medical charts in 39 clinics in Southwest Uganda to identify confirmed and suspected cancer cases. Subsequently, Suubi4Cancer will be evaluated via a randomized-controlled trial design (FDA + FLM + CE versus Usual Care) targeting a total of 78 youth ages 10-to-24 and their caregivers. Assessments at baseline and 9 months will examine change in cancer treatment access; cancer treatment adherence; and knowledge, attitudes, and beliefs about cancer and cancer treatment. Semi-structured interviews with the intervention group will explore their intervention experiences. To our knowledge, Suubi4Cancer will be the first study to test the preliminary impact and acceptability of a combination intervention to increase access to cancer diagnosis and treatment services for YLWHIV. TRIAL REGISTRATION Clinical Trials NCT03916783 (Registered: 04/16/19).
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Mostert S, Njuguna F, van der Burgt RHM, Musimbi J, Langat S, Skiles J, Seijffert A, Sitaresmi MN, Vik TA, van de Ven PM, Kaspers GJL. Health-care providers' perspectives on health-insurance access, waiving procedures, and hospital detention practices in Kenya. Pediatr Blood Cancer 2018; 65:e27221. [PMID: 29741267 DOI: 10.1002/pbc.27221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. PROCEDURE A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care. RESULTS The perspectives of respondents were as follows: all children with cancer should have health insurance according to 96% of HCP. After parents apply for health insurance, it takes too long before treatment costs are covered (67% agree). Patients with childhood cancer without health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving procedures take too long (75%). Parents are scared by waiving procedures and may decide never to return to the hospital again (68%). Poor families delay visiting the hospital because they fear hospital detention and first seek alternative treatment (92%). When poor families finally come to the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at the hospital if parents cannot pay their medical bills is not approved by 84% of HCP. CONCLUSIONS HCP acknowledge that access to health insurance needs improvement and that waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospital detention practices. These factors warrant urgent attention and adjustment.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Renske H M van der Burgt
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Joyce Musimbi
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anneloes Seijffert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mei N Sitaresmi
- Department of Pediatrics, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Terry A Vik
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Martijn HA, Njuguna F, Olbara G, Langat S, Skiles J, Martin S, Vik T, van de Ven PM, Kaspers GJ, Mostert S. Influence of health insurance status on paediatric non-Hodgkin's lymphoma treatment in Kenya. BMJ Paediatr Open 2017; 1:e000149. [PMID: 29637157 PMCID: PMC5862191 DOI: 10.1136/bmjpo-2017-000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes. DESIGN This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected. RESULTS Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063). CONCLUSIONS Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.
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Affiliation(s)
- Hugo A Martijn
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Martin
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry Vik
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Jl Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Njuguna F, Martijn HA, Kuremu RT, Saula P, Kirtika P, Olbara G, Langat S, Martin S, Skiles J, Vik T, Kaspers GJL, Mostert S. Wilms Tumor Treatment Outcomes: Perspectives From a Low-Income Setting. J Glob Oncol 2016; 3:555-562. [PMID: 29094095 PMCID: PMC5646879 DOI: 10.1200/jgo.2016.005389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Wilms tumor is the commonest renal malignancy in childhood. Survival in high-income countries is approximately 90%, whereas in low-income countries, it is less than 50%. This study assessed treatment outcomes of patients with Wilms tumor at a Kenyan academic hospital. Patients and Methods We conducted a retrospective medical record review of all children diagnosed with Wilms tumor between 2010 and 2012. Data on treatment outcomes and various sociodemographic and clinical characteristics were collected. Results Of the 39 patients with Wilms tumor, 41% had event-free survival, 31% abandoned treatment, 23% died, and 5% had progressive or relapsed disease. Most patients presented at an advanced stage: stage I (0%), II (7%), III (43%), IV (40%), or V (10%). The most likely treatment outcome in patients with low-stage (I to III) disease was event-free survival (67%), whereas in those with high-stage (IV to V) disease, it was death (40%). No deaths or instances of progressive or relapsed disease were recorded among patients with low-stage disease; their only reason for treatment failure was abandonment of treatment. Stage of disease significantly affected treatment outcomes (P = .014) and event-free survival estimates (P < .001). Age at diagnosis, sex, duration of symptoms, distance to hospital, and health insurance status did not statistically significantly influence treatment outcomes or event-free survival estimates. Conclusion Survival of patients with Wilms tumor in Kenya is lower compared with that in high-income countries. Treatment abandonment is the most common cause of treatment failure. Stage of disease at diagnosis statistically significantly affects treatment outcomes and survival.
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Affiliation(s)
- Festus Njuguna
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Hugo A Martijn
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Robert Tenge Kuremu
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Peter Saula
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Patel Kirtika
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Gilbert Olbara
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Sandra Langat
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Steve Martin
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Jodi Skiles
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Terry Vik
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Gertjan J L Kaspers
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Saskia Mostert
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
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