Cancer is a leading cause of death and disability in sub-Saharan Africa and will eclipse infectious diseases within the next several decades if current trends continue. Hematologic malignancies, ...including non-Hodgkin lymphoma, leukemia, Hodgkin lymphoma, and multiple myeloma, account for nearly 10% of the overall cancer burden in the region, and the incidence of non-Hodgkin lymphoma and Hodgkin lymphoma is rapidly increasing as a result of HIV. Despite an increasing burden, mechanisms for diagnosing, treating, and palliating malignant hematologic disorders are inadequate. In this review, we describe the scope of the problem, including the impact of endemic infections, such as HIV, Epstein-Barr virus, malaria, and Kaposi sarcoma–associated herpesvirus. We additionally describe current limitations in hematopathology, chemotherapy, radiotherapy, hematopoietic stem cell transplantation, and supportive care and palliation. We review contemporary treatment and outcomes of hematologic malignancies in the region and outline a clinical service and research agenda, which builds on recent global health successes combating HIV and other infectious diseases. Achieving similar progress against hematologic cancers in sub-Saharan Africa will require the sustained collaboration and advocacy of the entire global cancer community.
Background
Before the year 2000, there was no dedicated childhood cancer service in Cameroon. The aim of this study was to investigate the progress made with pediatric oncology care in Cameroon from ...2000 to 2020.
Method
A literature search was conducted for published articles on childhood cancer in Cameroon and relevant documents, and conference s were reviewed. The articles were analyzed under the themes: awareness, diagnosis, epidemiology, treatment, outcome, advocacy, partnerships, traditional and complementary medicine, palliative care, and capacity building.
Results
Low awareness on childhood cancer was addressed with education activities targeting the general population and health care professionals. Cancer diagnosis was achieved with cytology, histology, and simple imaging. Management for common and curable cancers was implemented with use of modified treatment regimens for low‐ and middle‐income settings. Nutritional support was shown to mitigate the effects of malnutrition on treatment toxicity, and support was provided for transportation and accommodation. There was good collaboration between the pediatric oncology professionals nationally and twinning with international partners. Capacity building activities led to the availability of three pediatric oncologists and pediatric oncology‐trained nurses. Advocacy nationally led to the support of the Ministry of Health with pediatric oncology‐specific priority actions in the latest national cancer control plan.
Conclusion
Childhood cancer should receive the necessary attention of health care policymakers in Cameroon. With continued commitment of government, nongovernmental organizations, charities, childhood cancer specialists, patient and parent groups, there should be an improved future for children with cancer in Cameroon.
Introduction
The International Society of Paediatric Oncology‐Paediatric Oncology in Developing Countries (SIOP‐PODC) group recommended graduated‐intensity retinoblastoma treatment for children in ...low‐ and middle‐income countries with limited local resources.
Aim
The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low‐income settings as recommended by the SIOP‐PODC recommendation in Cameroon.
Methods
Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP‐PODC guidelines for low‐income countries. Endpoint was survival at 24 months. Kaplan–Meier curves with log‐rank (Mantel–Cox) chi‐square (χ2) with respective p‐values were prepared.
Results
Eighty‐two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1–112 months; standard deviation SD 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error SE 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001).
Conclusion
Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP‐PODC‐proposed management guidelines for retinoblastoma in a lower middle‐income setting.
Abstract
Introduction
Reduced fertility risk is a risk in females treated with a high cumulative cyclophosphamide (CPM) dose.
Objectives
The objective of this study is to establish the age at ...menarche, record all pregnancies, calculate age-specific fertility rate (ASFR) in female BL survivors, treated in Cameroon, in the age groups 15–19 and 20–24 years, and association with an increasing cumulative CPM dose.
Methods
Data collection included personal data and telephone interviews for female survivors, aged ≥12 years with regards to menarche age, their mothers’ menarche age, incidence and outcome of all pregnancies. The cumulative CPM/m2 dose was categorized as low (<4723 mg/m2), medium (4724–10 635 mg/m/2) or high (>10 635 mg/m2).
Results
The median age at first treatment for 113 patients was 8 years (range 3–17 years), with median current age 17 years (range 12–26 years); the median duration of follow-up was 9 years (range 1.2–13.3 years). The median age of patients at menarche (n = 109; 4 unknown) was 14 years (range 10–17 years, SD 1.19) and that of their mothers (n = 68; 45 unknown) 15 years (range 10–17 years, SD 1.53). The median time to first pregnancy following menarche (the fertility time) was 3.04 years (n = 10) with low-dose CPM, 6.09 years with medium-dose CPM (n = 81) and 6.04 years with high-dose CPM (n = 32) (log rank difference p = 0.420). The ASFR in the age group 15–19 years was 82.19 (n = 73) and in the age group 20–24 years was 863.6 (n = 22), with significantly lower ASFR (p > 0.001) in children treated before the age of 10 years.
Conclusion
Fertility rates of girls treated for BL with CPM were normal but reduced in patients who commenced treatment before the age of 10 years.
Abstract
Effective cancer registration is required for the development of cancer management policies, but is often deficient in the developing world. In 2008 cancer registration was set up Banso ...Baptist Hospital and Mbingo Baptist Hospital in the Northwest region of Cameroon, using the Pediatric Oncology Networked Database (POND). The objective of this study was to analyze the POND registry data for patients with cancer aged 0–15 years for the period 2004–15. A total of 1029 malignancies were recorded in children 0–15 years in the study period. The male-to-female ratio was 1.4:1. The median age at diagnosis was 7.22 years. The most common malignancies were lymphomas followed by nephroblastoma, retinoblastoma, rhabdomyosarcoma and Kaposi sarcoma. There were more Burkitt lymphomas cases between 2004 and 2009 than between 2010 and 2015, while the number of cases rose for other diagnoses like retinoblastoma and nephroblastoma. This report has demonstrated how pediatric oncology registration can be implemented, improved and sustained in a low- and middle-income country setting with limited resources. Using the data, these hospitals can improve their treatment planning and ensure the availability of essential chemotherapy for childhood cancers.
Over 80% of children with cancer live in low and middle-income countries where survival rates are much lower than high-income countries. Challenges to successful treatment of paediatric cancers in ...these countries include late presentation, malnutrition, failure to complete treatment and less-intense supportive care leading to increased treatment-related mortality and the need to reduce the intensity of treatment. Clinical trials can contribute to improved care and survival by providing objective information on the number of patients treated, accuracy of diagnosis, causes of treatment failure and the efficacy of specific interventions. Clinical trials can also help to build capacity (salary support and training), improve facilities (equipment) and fund treatment or essential associated costs (social support, nutritional support and follow-up care). In this article, we discuss our experience with clinical trials in Malawi and sub-Saharan Africa with emphasis on the treatment of children with Wilms tumour.
The Western Cape Province of South Africa, an area with a high tuberculosis (TB) incidence, where initial multidrug resistance (MDR) among adult TB cases was 1.1% during 1992-1993.
To determine the ...long-term prevalence of TB infection and disease in children in household contact with adults with MDR pulmonary TB, and to establish the efficacy of chemoprophylaxis in preventing disease in these children.
Children <5 years old in contact with 73 MDR TB adults were evaluated. Disease was treated by prescribing at least 2 drugs to which the adult's strain was susceptible. The remaining children were classified as infected or noninfected and received chemoprophylaxis according to the index's strain susceptibility or were followed up and treated when indicated. All were followed up for 30 months.
At the initial evaluation 125 children were seen, median age 27.5 months. Of these, 119 were followed up. Fourteen (12%) had disease, 61 (51%) were infected only, and 44 (37%) were noninfected. By 30-month follow-up, 29 (24%) had developed disease and 64 (54%) were infected only. Four adult-child pair Mycobacterium tuberculosis isolates were compared by DNA fingerprinting; 3 were identical. All children who developed TB disease were clinically cured. Two (5%) of 41 children who received appropriate chemoprophylaxis and 13 (20%) of 64 who did not, developed TB during follow-up (odds ratio: 4.97).
The study confirms MDR TB transmission to childhood contacts. Seventy-eight percent of children were infected or developed disease. Appropriate chemoprophylaxis may prevent disease in these children.
Abstract
Significant strides have been made in the treatment of childhood cancer. Improvements in survival have led to increased attention toward supportive care indications; including the use of ...traditional and complementary medicine (T&CM). The use of T&CM among children and adolescents with cancer is well documented in both high-income countries (HICs) and low-middle income countries (LMICs). A higher incidence of the use of T&CM has been reported among children undergoing treatment in LMICs, which has elevated concerns related to drug interactions, adherence to therapy, and treatment-related toxicities. These observations have underscored the need for effective models of integrative care that are culturally sensitive yet sustainable in an LMIC setting. We present considerations inclusive of the clinical care, educational opportunities, governmental policy, and research priorities necessary for the development of models of integrative care for pediatric cancer units in an LMIC setting.
The survival rate of Wilms tumour (WT) in low-income sub-Saharan countries in Africa is below 50%. Thirty-five consecutive children diagnosed with WT between 2007 and 2012 at Mbingo Baptist Hospital, ...Cameroon, were observed in this study and treated with a modified International Society of Paediatric Oncology (SIOP) treatment protocol. Our objective was to achieve a significant overall cure rate in patients with WT. This report describes the long-term outcome of patients treated at Mbingo Baptist hospital (MBH) in northwest Cameroon. This consisted of preoperative chemotherapy, nephrectomy and post-operative chemotherapy depending on the stages of the disease and histological findings. Radiotherapy was not available. The diagnosis and staging was based on abdominal ultrasound (US), chest X-Ray and the histological findings at nephrectomy and surgery and/or fine needle aspirate (FNA). The cohort included 17 boys and 18 girls with a median age of 3.5 years (range 6 months to 9 years). The surgical stage distribution was: stage I = 9; II = 3; III = 5; IV = 12; V = 3; undetermined = 3 patients. Three guardians refused surgery; there were three deaths related to surgery and two deaths during preoperative chemotherapy. All relapses occurred within 12 months. The survival rate was significantly better in stages I and II than in stages III and IV of cancer. Two of the three patients with bilateral WT are long-term survivors. The overall projected survival rate after a median follow-up of 84 months (range 4-125 months) was 44%. One patient in remission was lost to follow-up after 4 months. All patients admitted with a diagnosis of WT were included in the Kaplan-Meier survival analysis. With this treatment schedule followed for more than 50% of the patients, it can be concluded that obtaining consent from every guardian for nephrectomy and preventing deaths related to surgery and chemotherapy could improve the overall survival rate of all patients diagnosed with WT.
Background:
Palliative care (PC) is the most appropriate treatment for patients with life-limiting, incurable diseases, but it is a relatively new concept in sub-Saharan Africa (SSA). A lack of ...curative treatment options for some conditions creates a great need for PC, but such services are rarely provided in SSA. More research into PC in SSA is urgently needed to create an evidence base to confirm the importance of appropriate PC services.
Objectives:
To gain a better understanding of the needs of patients and their families visited by a children's PC nurse in Cameroon and to identify aspects of the service that can be improved.
Methodology:
A qualitative study design with semi-structured interviews was used. Tape-recorded interviews were transcribed and thematically analysed.
Results:
Twelve interviews were conducted with patients, carers and nurses. Financial aid, general disease improvement and prayers were the directly expressed needs of service recipients. Specialist training in children's PC was the main need expressed by the nurses. Open communication about clinical status and treatment failure, more detailed counselling, more distraction for patients and respite for carers were identified as underlying needs.
Conclusion:
It is possible to provide an effective children's PC service that meets the most urgent needs of recipients in a rural setting in SSA. Recommendations include improved counselling, specialist education for staff, expansion of local support networks and more frequent home visits. More studies are needed to help define the need for PC in children with life-limiting diseases.
PDF
