The role of age and sex in the presentation and outcome of endemic Burkitt lymphoma (BL) has not been studied recently. This study analysed these factors in 934 patients with BL who had received ...cyclophosphamide and intrathecal methotrexate as treatment.
Records of 934 children diagnosed with BL from 2004 to 2015 were obtained from our Paediatric Oncology Networked Database (POND) cancer registry. Age at diagnosis, sex, disease stage, time to diagnosis, delay in diagnosis, completion of treatment, rate of abandonment, and one-year survival rates were recorded and statistically analysed.
The male to female ratio of 1.41 for the study population of 934. The median delay from onset of symptoms to diagnosis was 31 days. The St Jude stage distribution was I = 6.4%, II = 5.9%, III = 71.5% and IV = 16.2%. Significantly more patients presented with stage III disease in age groups 5-9 and 10-14 years than 0-4 years. The overall 1-year survival rate was 53.45%, respectively 77.1% for stage I, 67.9% for stage II, 55.1% for stage III and 32.4% for stage IV disease (p<0.001). There was no significant difference in survival by sex and age group.
Patients aged under 5 years presented with less-advanced disease, but survival was not affected by age. Sex did not influence delay to diagnosis and overall survival. The long delay between the onset of symptoms and diagnosis emphasises the need for interventions to achieve an earlier diagnosis and a better survival rate.
Background
‘Treatmentabandonment’ is a common and preventable cause of childhood cancer treatment failure in low‐ and middle‐income countries (LMIC). Risk factors and effective interventions in LMIC ...are reported. Poverty and costs of treatment are perceived as overriding causes in sub‐Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub‐Saharan Africa, to be better informed for planned future interventions.
Methods
A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub‐Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment.
Results
We included 252 patients (median age 6.0, range 0.2–15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026).
Conclusions
Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub‐Saharan Africa.
Background
The Collaborative Wilms Tumour (WT) Africa Project has implemented an adapted WT treatment guideline in sub‐Saharan Africa as a multi‐centre prospective clinical trial. A retrospective, ...baseline evaluation of end‐of‐treatment outcome was performed for a 2‐year period prior to the introduction of this guideline. The collaborative project aims to reduce both treatment abandonment and death during treatment to less than 10% for improving survival.
Procedure
All participating centres obtained local Institutional Research Board (IRB) approval and implemented the adapted WT treatment guideline. End‐of‐treatment outcome was documented for 2 years. It was divided into alive without evidence of disease, treatment abandonment, death during treatment and persistent disease. The outcome of children enroled in the first 2 years of the prospective clinical trial has been compared to the outcome before the start of the project.
Results
One hundred twenty‐two patients were included in the baseline evaluation (2011–2012) and 133 in the first 2 years of the collaborative clinical trial (2014–2015). The percentage of patients alive without evidence of disease at the end of treatment increased from 52% (63/122) to 68% (90/133; P = 0.01). Treatment abandonment decreased from 23% (28/122) to 13% (17/133; P = 0.03). Death during treatment decreased from 21% (26/122) to 13% (17/133; P = 0.07).
Conclusion
This collaboration, using relatively simple and low‐cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment.
Background
Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment‐related and disease‐related causes. To prevent these deaths, it is ...important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment.
Methods
We conducted a multicentre prospective, observational cohort study in sub‐Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were ed in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented.
Results
We included 252 patients (median age 6.0, range 0.2–15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment‐related cause. Treatment‐related mortality of all patients in the first 3 months of treatment was 13% (33/252).
Conclusion
Fifteen percent of patients had an early death during treatment and 13% had a treatment‐related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.
Background
Death during paediatric cancer treatment is common in sub‐Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to ...describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention.
Methods
A multicentre prospective, observational cohort study was conducted in sub‐Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were ed in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented.
Results
A total of 252 patients were included (median age 6.0, range 0.2–15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109/L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes.
Conclusions
Although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment‐related mortality.
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.
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.
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.
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.
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.
Aim
Early cancer diagnosis is necessary to improve survival rates. The aim of this study was to assess the outcome and cost of the childhood cancer training programme amongst healthcare workers.
...Design
This was a prospective pre–post study design, using questionnaires for pre‐ and post‐training testing. The warning signs of childhood cancer were used as the main teaching content to improve recognition and early diagnosis.
Methods
Pre‐training and post‐training knowledge, as well as attitude questionnaires, was administered at the beginning and at the end of each training workshop. Paired samples t test and chi‐square were used to compare the change in knowledge and differences between groups.
Results
The overall percentage knowledge score increased from 51%–85% (p < .001). The doctors had a better knowledge score than the nurses in the pre‐test (70% versus 50%, p = .008), but there was no significant difference in the post‐test scores. The cost of training was €25.06 per healthcare worker.
Conclusion
We recommend similar training programmes in public health to improve early diagnosis of childhood cancer.
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