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Farrag A, Ghazaly MH, Mohammed K, Volland R, Hero B, Berthold F. Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country. BMC Pediatr 2023; 23:443. [PMID: 37670249 PMCID: PMC10478379 DOI: 10.1186/s12887-023-04214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC). METHODS A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors. RESULTS The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma. CONCLUSIONS Outcome differences were associated with different causes of death and other less prominent factors.
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Affiliation(s)
- Ahmed Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
| | | | - Khaled Mohammed
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Volland
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Statistics, University Hospital of Cologne, Cologne, Germany
| | - Barbara Hero
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
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Gupta S, Morris SK, Suraweera W, Aleksandrowicz L, Dikshit R, Jha P. Childhood Cancer Mortality in India: Direct Estimates From a Nationally Representative Survey of Childhood Deaths. J Glob Oncol 2016; 2:403-411. [PMID: 28717727 PMCID: PMC5493242 DOI: 10.1200/jgo.2015.000935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Although most children with cancer live in low- and middle-income countries, measurements of childhood cancer burden in such countries have been restricted to incidence rates from a few subnational cancer registries and mortality rates from vital statistics. We aimed to provide alternative burden estimates by using nationally representative longitudinal survey–derived mortality rates. Methods We examined cancer deaths in childhood (1 month to 14 years of age) in the Million Death Study, a cohort of > 27,000 pediatric deaths in India on the basis of enhanced verbal autopsies. All deaths potentially due to childhood cancer were identified. Two pediatric specialists independently categorized deaths as definite, probable, possible, or unlikely cancer related. From definite and probable deaths, we estimated national and regional mortality rates attributable to childhood malignancies. Data on symptoms and health care–seeking behavior were abstracted from closed-ended questions and caregiver narratives. Results Of 700 included deaths, 189 were classified as definite or possibly cancer related. The κ-statistic between reviewers was 0.75 (95% CI, 0.71 to 0.78). From these deaths, we estimated that in 2010, 13,700 were a result of childhood cancer in India, which led to a mortality rate of 37 (95% CI, 31 to 42) per million population per year, which exceeds many prior estimates of mortality and even some estimates of incidence. Disparities between mortality estimates were widest in northeast India and for brain tumors. A preponderance of male deaths was seen (male:female ratio, 1.6:1). Conclusion The burden of childhood cancer in India is substantially higher than previously suggested. This information will aid advocacy for national strategies aimed at improving outcomes for Indian children with cancer.
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Affiliation(s)
- Sumit Gupta
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Shaun K Morris
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Wilson Suraweera
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Lukasz Aleksandrowicz
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Rajesh Dikshit
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Prabhat Jha
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
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de Robles P, Fiest KM, Frolkis AD, Pringsheim T, Atta C, St Germaine-Smith C, Day L, Lam D, Jette N. The worldwide incidence and prevalence of primary brain tumors: a systematic review and meta-analysis. Neuro Oncol 2014; 17:776-83. [PMID: 25313193 DOI: 10.1093/neuonc/nou283] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/21/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary brain tumors are a heterogeneous group of benign and malignant tumors arising from the brain parenchyma and its surrounding structures. The epidemiology of these tumors is poorly understood. The aim of our study is to systematically review the latest literature on the incidence and prevalence of primary brain tumors. METHODS The systematic review and meta-analysis were conducted according to a predetermined protocol and established guidelines. Only studies reporting on data from 1985 onward were included. Articles were included if they met the following criteria: (i) original research, (ii) population based, (iii) reported an incidence or prevalence estimate of primary brain tumors. RESULTS From the 53 eligible studies overall, 38 were included in the meta-analysis. A random-effects model found the overall incidence rate of all brain tumors to be 10.82 (95% CI: 8.63-13.56) per 100 000 person-years. The incidence proportion estimates were heterogeneous, even among the same tumor subtypes, and ranged from 0.051 per 100 000 (germ cell tumors) to 25.48 per 100 000 (all brain tumors). There were insufficient data to conduct a meta-analysis of the prevalence of primary brain tumors. CONCLUSIONS There is a need for more accurate and comparable incidence and prevalence estimates of primary brain tumors across the world. A standardized approach to the study of the epidemiology of these tumors is needed to better understand the burden of brain tumors and the possible geographical variations in their incidence.
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Affiliation(s)
- Paula de Robles
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Kirsten M Fiest
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Alexandra D Frolkis
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Callie Atta
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Christine St Germaine-Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Lundy Day
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Darren Lam
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.M.F., C.A., T.P., C.S., L.D., D.L., N.J.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (P.d.R., K.F., T.P., D.L., N.J.); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (K.F., A.D.F., T.P., N.J.); Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (K.F, A.D.F., T.P., N.J.); Department of Oncology, University of Calgary, Calgary, Alberta, Canada (P.d.R.)
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