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Rabelo BS, de Alvarenga KAF, Fernando Lopes L, Guimarães Ribeiro A, de Sá Rodrigues KE. Strategies to improve diagnosis and access to treatment of retinoblastoma in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2024; 71:e30987. [PMID: 38594882 DOI: 10.1002/pbc.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, 21 met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance, and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts toward improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients.
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Affiliation(s)
- Bruna Salgado Rabelo
- Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
| | - Kevin Augusto Farias de Alvarenga
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
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2
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Nguyen GT, Gauvreau C, Mansuri N, Wight L, Wong B, Neposlan J, Petricca K, Denburg A. Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2024; 8:e002556. [PMID: 38830723 PMCID: PMC11149138 DOI: 10.1136/bmjpo-2024-002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs. METHODS We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted. RESULTS 93 studies (1992-2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions. CONCLUSIONS Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.
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Affiliation(s)
- Gina T Nguyen
- University College Dublin School of Medicine, Dublin, Ireland
| | - Cindy Gauvreau
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lisa Wight
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bryan Wong
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Josh Neposlan
- University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Kadia Petricca
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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3
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Wongsawatkul O, Buachan P, Jaisin Y, Busarakumtragul P, Chainakul S, Watanapokasin R, Prachayasittikul V, Prachayasittikul S, Ruchirawat S, Prachayasittikul V. Effects of barakol from Cassia siamea on neuroblastoma SH-SY5Y cell line: A potential combined therapy with doxorubicin. Heliyon 2024; 10:e24694. [PMID: 38318050 PMCID: PMC10839565 DOI: 10.1016/j.heliyon.2024.e24694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
Management of neuroblastoma is challenging because of poor response to drugs, chemotherapy resistance, high relapse, and treatment failures. Doxorubicin is a potent anticancer drug commonly used for neuroblastoma treatment. However, doxorubicin induces considerable toxicities, particularly those caused by oxidative-related damage. To minimize drug-induced adverse effects, the combined use of anticancer drugs with natural-derived compounds possessing antioxidant properties has become an interesting treatment strategy. Barakol is a major compound found in Cassia siamea, an edible plant with antioxidant and anticancer properties. Therefore, barakol could potentially be used in combination with doxorubicin to synergize the anticancer effect, while minimizing the oxidative-related toxicities. Herein, the potential of barakol (0.0043-43.0 μM) to synergize the anticancer effect of low-dose doxorubicin (0.5 and 1.0 μM) was investigated. Results indicated that barakol could enhance the cytotoxic effect of low-dose doxorubicin by affecting the cell viability of the treated cells. Furthermore, the co-treatment with barakol and low-dose doxorubicin decreased the levels of intracellular ROS when compared with the control. Moreover, the antimetastatic effect of the barakol itself was studied through its ability to inhibit metalloproteinase-3 (MMP-3) activity and prevent cell migration. Results revealed that the barakol inhibited MMP-3 activity and prevented cell migration in time- and dose-dependent manners. Additionally, barakol was a non-cytotoxic agent against the normal tested cell line (MRC-5), which suggested its selectivity and safety. Taken together, barakol could be a promising compound to be further developed for combination treatment with low-dose doxorubicin to improve therapeutic effectiveness but decrease drug-induced toxicities. The inhibitory effects of barakol on MMP-3 activity and cancer cell migration also supported its potential to be developed as an antimetastatic agent.
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Affiliation(s)
- Orapin Wongsawatkul
- Department of Pharmacology, Faculty of Medicine, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Paiwan Buachan
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, 10700, Thailand
| | - Yamaratee Jaisin
- Department of Pharmacology, Faculty of Medicine, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Panaree Busarakumtragul
- Department of Physiology, Faculty of Medicine, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Sunan Chainakul
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Ramida Watanapokasin
- Department of Biochemistry, Faculty of Medicine, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Veda Prachayasittikul
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, 10700, Thailand
| | - Supaluk Prachayasittikul
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, 10700, Thailand
| | - Somsak Ruchirawat
- Laboratory of Medicinal Chemistry, Chulabhorn Research Institute, Bangkok, 10210, Thailand
- Program in Chemical Sciences, Chulabhorn Graduate Institute, Bangkok, 10210, Thailand
- Center of Excellence on Environmental Health and Toxicology (EHT), Commission on Higher Education, Ministry of Education, Bangkok, 10400, Thailand
| | - Virapong Prachayasittikul
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, 10700, Thailand
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Penido Mendes de Sousa CF, Pasetsky J, Marta GN, Kassick M, Moraes FY, Dad LK. Smart Solutions to Address the Global Gap in Radiation Oncology Through Trainee Engagement and Partnerships with Industry. Hematol Oncol Clin North Am 2024; 38:217-228. [PMID: 37516632 DOI: 10.1016/j.hoc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Radiation therapy is a critical modality for cancer treatment. Greater than 80% of the global population lack access to and expertise with the technological advancements that allow for state-of-the-art treatments that are more accessible in the West. What follows is a review of a two-pronged solution to help address this global gap to technology and innovation: (1) trainee engagement and (2) industry partnerships. We hope to galvanize our readers to see the immense potential for success if we may synergize efforts in education and with our partners in private industry to help address critical unmet needs in emerging economies of the globe.
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Affiliation(s)
| | - Jared Pasetsky
- Columbia University Irving Medical Center - 630 West 168th Street, New York, NY 10032, USA
| | - Gustavo Nader Marta
- Hospital Sírio-Libanês - Rua Dona Adma Jafet, São Paulo-SP, Bela Vista, 01308-050 Brazil
| | - Megan Kassick
- Department of Radiation Oncology, University of Pennsylvania - 3400 Civic Boulevard, Philadelphia, PA 19104-6021, USA
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, 25 King Street West, Burr Wing, Kingston, Ontario K7L 5P9, Canada.
| | - Luqman K Dad
- Columbia University Irving Medical Center - 630 West 168th Street, New York, NY 10032, USA
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Malo C, Oliván S, Ochoa I, Shikanov A. In Vitro Growth of Human Follicles: Current and Future Perspectives. Int J Mol Sci 2024; 25:1510. [PMID: 38338788 PMCID: PMC10855051 DOI: 10.3390/ijms25031510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Ovarian tissue cryopreservation is gaining importance as a successful method to restore fertility to girls and young women at high risk of sterility. However, there are concerns regarding the safety of transplantation after ovarian tissue cryopreservation due to the high risk of reintroducing cancer cells and causing disease recurrence. In these cases, the development of culture systems that support oocyte development from the primordial follicle stage is required. Notable achievements have been reached in human follicle in vitro growth in the past decade. Currently, systems for the in vitro culture of ovarian tissue are based on two-dimensional substrates that do not support the survival of follicles or recapitulate the mechanical heterogenicity in the mammalian ovary. Recognition of the importance of special arrangements between cells has spurred research in three-dimensional culture systems, and the provision of a precise culture system that maximizes the diffusion of nutrients and gases through the follicles has raised interest in advanced biomimetic models. The current review critically examines various culture systems employed for the in vitro development of follicles, with a particular focus on solutions utilizing Organ-on-a-Chip (OOC) technology. The emphasis on OOC technology underscores its role as a promising avenue in ensuring the successful cultivation and maintenance of follicular structures during the culture period.
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Affiliation(s)
- Clara Malo
- Tissue Microenvironment (TME) Lab, Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain; (S.O.); (I.O.)
- Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Sara Oliván
- Tissue Microenvironment (TME) Lab, Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain; (S.O.); (I.O.)
- Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Ignacio Ochoa
- Tissue Microenvironment (TME) Lab, Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain; (S.O.); (I.O.)
- Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, 50018 Zaragoza, Spain
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Cellular and Molecular Biology Program, University of Michigan, Ann Arbor, MI 48109, USA
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Wong KA, Moskalewicz A, Nathan PC, Gupta S, Denburg A. Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review. J Cancer Surviv 2024:10.1007/s11764-023-01517-8. [PMID: 38183576 DOI: 10.1007/s11764-023-01517-8] [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: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Physical late effects of treatment are well-documented among childhood cancer survivors in high-income countries, but whether prevalence and risk factors are comparable in low- and middle-income countries (LMICs) is unclear. We conducted a systematic review to assess physical late effect outcomes among childhood cancer survivors in LMICs. METHODS Five health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs that evaluated physical late effects of treatment in childhood cancer survivors. Mean or median cohort follow-up must have been ≥ 5 years from original cancer diagnosis. RESULTS Sixteen full articles and five conference abstracts were included. Studies were conducted in lower-middle (n = 12, 57%) or upper-middle income (n = 9, 43%) countries; nearly half (n = 9, 43%) were conducted in India. Five cohorts (24%) were comprised entirely of 5-year survivors. Subsequent malignant neoplasms were reported in 0-11% of survivors (n = 10 studies). Hypothyroidism and metabolic syndrome prevalence ranged from 2-49% (n = 4 studies) and 4-17% (n = 5 studies), respectively. Gonadal dysfunction ranged from 3-47% (n = 4 studies). Cardiac dysfunction ranged from 1-16% (n = 3 studies). Late effects of the musculoskeletal and urinary systems were least investigated. CONCLUSIONS Substantial knowledge gaps exist in LMIC childhood cancer survivorship. No low-income country data were found. In middle-income countries, late effects were defined and assessed variably and limited by selection bias and small sample sizes. IMPLICATIONS FOR CANCER SURVIVORS Survivors in LMICs can experience physical late effects of treatment, though additionally systematically collected data from survivor cohorts are needed to fill knowledge gaps.
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Affiliation(s)
- Kevin A Wong
- Faculty of Health Sciences, McMaster University, Hamilton, L8S 4K1, Canada
| | | | - Paul C Nathan
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Sumit Gupta
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Avram Denburg
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
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Joseph A, Akinsete AM, Lasebikan NN, Adeneye S, Awofeso OM, Oladipo AT, Ajose AO, Ojo O, Merrell K, Ngwa W, Puthoff DS, Onitilo AA. The Landscape of Pediatric Radiation Oncology in Nigeria. JCO Glob Oncol 2024; 10:e2300219. [PMID: 38207247 DOI: 10.1200/go.23.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Hematology & Oncology Unit, Department of Pediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Samuel Adeneye
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Opeyemi M Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Aishat T Oladipo
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat O Ajose
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatimileyin Ojo
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A Onitilo
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
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Lukamba RM, Budiongo AN, Monga BB, Yao A, Bey P, Chenge GB, Desjardins L, Doz F, Mwembo AT, Kabesha TA, Luboya ON. Treatment adherence in retinoblastoma: A retro-prospective cohort study in Ivory Coast and the Democratic Republic of Congo. Cancer Rep (Hoboken) 2023; 7:e1949. [PMID: 38146612 PMCID: PMC10849925 DOI: 10.1002/cnr2.1949] [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: 06/28/2023] [Revised: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND In high-income countries, retinoblastoma is curable in more than 95% of cases, whereas in low-income countries, mortality remains high, especially when the diagnosis is made late or the treatment is discontinued. AIMS To determine the factors associated with adherence to the treatment of retinoblastoma in the Ivory Coast and the Democratic Republic of Congo (DRC). METHODS AND RESULTS A retro-prospective cohort study was carried out. Data were collected from patient folders and follow-up records of parents. RESULTS A total of 175 children with retinoblastoma were registered from January 2013 to December 2015. Seventy-six children (43%) were 5 years old and above. Care costs were covered by families in 86.9% of cases. Chemotherapy refusal was recorded in 39 cases (22.3%), and enucleation refusal was recorded in 79 cases (45.1%). After 36 months of follow-up, we recorded 16.6% deaths, 27.4% treatment dropouts, and 18.3% loss to follow-up after treatment. The commonest cause for enucleation refusal was fear of infirmity, while chemotherapy refusal and absconding treatment were due to financial constraints. CONCLUSION Poor adherence to retinoblastoma management was due to financial constraints, and a lack of knowledge of the disease and its treatment. Family psychosocial support is needed to improve this condition.
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Affiliation(s)
- Robert Mbuli Lukamba
- Department of Pediatrics (Pediatric Oncology Unit)University of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Aléine Nzazi Budiongo
- Department of Pediatrics (Pediatric Oncology Unit)University of KinshasaKinshasaDemocratic Republic of the Congo (DRC)
| | - Ben Bondo Monga
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Atteby Yao
- Pediatric Oncology UnitUniversity Teaching Hospital of TreichvilleAbidjanIvory Coast
| | - Pierre Bey
- Advisor to the President of Institut CurieUniversity of Lorraine and AMCCParisFrance
| | | | | | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research in Child Oncology, Adolescent and Young Adult) Institut Curie and University Paris CitéParisFrance
| | - Albert Tambwe Mwembo
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | | | - Oscar Numbi Luboya
- Department of Pediatrics and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
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Israels T, Arora RS, Sung L. The value of reporting on end-of-treatment outcome of patients in low-income settings. Pediatr Blood Cancer 2023; 70:e30686. [PMID: 37728943 DOI: 10.1002/pbc.30686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Trijn Israels
- Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Lillian Sung
- Sick Children's Hospital, Toronto, Ontario, Canada
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Sichali J, Denburg A, Khofi H, Mdoka C, Nyirenda D, Chimalizeni Y, Chagaluka G, Molyneux E, Henrion MYR, Gupta S, Israels T. Prevention of treatment abandonment in sub-Saharan Africa; Lessons learned in Malawi that guide the way forward to cost-effective interventions: A report from CANCaRe Africa. Pediatr Blood Cancer 2023; 70:e30654. [PMID: 37644661 DOI: 10.1002/pbc.30654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Junious Sichali
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
| | - Avi Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harriet Khofi
- Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Cecilia Mdoka
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
| | | | | | | | | | - Marc Y R Henrion
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trijn Israels
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
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Banayat AC, Abad PJB, Bonito SR, Manahan LT, Peralta AB. Care Needs of Parents of Children With Cancer in a Low-Middle-Income Country. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:295-304. [PMID: 37885214 DOI: 10.1177/27527530231193972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background: Mapping out actual supportive care needs assists nurses in providing holistic individualized care. This study aimed to explore the care needs of parents of children with cancer in the Philippines. Method: Guided by the Supportive Care Needs Framework (SCNF), this study used an embedded mixed-method design with the quantitative revised Cancer Patient Needs Questionnaire and qualitative semistructured interviews to describe parents' care needs and priorities. Results: Filipino parents (N = 156) of children with cancer have various care needs which could be classified along the SCNF categories-practical, informational, spiritual, physical, emotional, and physical needs as ranked from highest to lowest. A number of variables were significantly associated with care needs. Solid tumor diagnosis was associated with greater practical, emotional, and psychosocial care needs; having a child who had undergone surgery was associated with more practical and spiritual care needs; and being within one year of the child's diagnosis was associated with practical, psychosocial, and spiritual care needs. Parent priority needs included (a) addressing financial needs; (b) access to temporary housing to minimize treatment-related costs; (c) support groups among parents of children with cancer as a source of information; (d) financial and social support between members of family and partners of parents of children with cancer; and (e) using prayer to facilitate acceptance. Conclusions: Supportive care needs of parents of children with cancer are important components of care that should be given recognition to enhance holistic individualized care throughout the childhood cancer experience.
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Affiliation(s)
| | - Peter James B Abad
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Sheila R Bonito
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Lydia T Manahan
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Arnold B Peralta
- College of Nursing, University of the Philippines Manila, Manila, Philippines
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van Weelderen RE, Wijnen NE, Njuguna F, Klein K, Vik TA, Olbara G, Kaspers GJL. Treatment outcomes of pediatric acute myeloid leukemia in Western Kenya before and after the implementation of the SIOP PODC treatment guideline. Cancer Rep (Hoboken) 2023; 6:e1849. [PMID: 37349659 PMCID: PMC10432428 DOI: 10.1002/cnr2.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE The Pediatric Oncology in Developing Countries (PODC) committee of the International Society of Pediatric Oncology (SIOP) published a pediatric acute myeloid leukemia (AML)-specific adapted treatment guideline for low- and middle-income countries. We evaluated the outcomes of children with AML at a large Kenyan academic hospital before (period 1) and after (period 2) implementing this guideline. PATIENTS AND METHODS Records of children (≤17 years) newly diagnosed with AML between 2010 and 2021 were retrospectively studied. In period 1, induction therapy comprised two courses with doxorubicin and cytarabine, and consolidation comprised two courses with etoposide and cytarabine. In period 2, a prephase with intravenous low-dose etoposide was administered prior to induction therapy, induction course I was intensified, and consolidation was adapted to two high-dose cytarabine courses. Probabilities of event-free survival (pEFS) and overall survival (pOS) were estimated using the Kaplan-Meier method. RESULTS One-hundred twenty-two children with AML were included - 83 in period 1 and 39 in period 2. Overall, 95 patients received chemotherapy. The abandonment rate was 19% (16/83) in period 1 and 3% (1/39) in period 2. The early death, treatment-related mortality, complete remission, and relapse rates in periods 1 and 2 were 46% (29/63) versus 44% (14/32), 36% (12/33) versus 47% (8/17), 33% (21/63) versus 38% (12/32), and 57% (12/21) versus 17% (2/12), respectively. The 2-year pEFS and pOS in periods 1 and 2 were 5% versus 15% (p = .53), and 8% versus 16% (p = .93), respectively. CONCLUSION The implementation of the SIOP PODC guideline did not result in improved outcomes of Kenyan children with AML. Survival of these children remains dismal, mainly attributable to early mortality.
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Affiliation(s)
- Romy E. van Weelderen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Noa E. Wijnen
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Festus Njuguna
- Child Health and PediatricsMoi University/Moi Teaching and Referral HospitalEldoretKenya
| | - Kim Klein
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Terry A. Vik
- PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gilbert Olbara
- Child Health and PediatricsMoi University/Moi Teaching and Referral HospitalEldoretKenya
| | - Gertjan J. L. Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
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Damasco-Avila E, Zelaya Sagastizado S, Carrillo M, Blanco J, Fu L, Espinoza D, Ladas EJ. Improving the Quality of the Delivery of Nutritional Care Among Children Undergoing Treatment for Cancer in a Low- and Middle-Income Country. JCO Glob Oncol 2023; 9:e2300074. [PMID: 37384860 PMCID: PMC10497261 DOI: 10.1200/go.23.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE International twinning programs have been well-established between institutions in childhood cancer and have led to pediatric cancer units in low- and middle-income countries (LMICs) adopting multidisciplinary forms of care. To advance nutritional care in LMICs, the International Initiative for Pediatrics and Nutrition (IIPAN) provided the structural framework and personnel for the delivery of nutritional care. We describe the impact of a newly established nutrition program on the delivery of nutritional care and nutrition-related clinical outcomes in children and adolescents undergoing treatment for cancer in Nicaragua and Honduras. METHODS A prospective cohort (N = 126) collected clinical data over a 2-year period. Collection of IIPAN's nutritional services received during treatment and clinical data were abstracted from medical charts and registered in Research Electronic Data Capture (REDCap) database. Chi-square, ANOVA, and generalized linear mixed models were used; P < .05 was considered statistically significant. RESULTS Nutritional assessments led to a higher number of patients receiving recommended standard of care. Children classified as underweight during treatment presented higher number of infections and toxicities, length of hospital stay, and days of treatment delays during treatment. Overall, from the start to end of treatment, 32.5% of patients improved nutritional status, 35.7% maintained it, and 17.5% worsened. On the basis of metrics, the cost per consultation was less than 4.80 US dollars (USD; Honduras) and 1.60 USD (Nicaragua). CONCLUSION Integration and equitable access of the nutritional care process for all patients needs to be recognized as a component of the basic management in pediatric oncology care. IIPAN's nutritional program demonstrates that nutritional care is economical and feasible in a limited resource setting.
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Affiliation(s)
- Erika Damasco-Avila
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY
| | | | - María Carrillo
- Department of Hematology/Oncology, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua
| | - Jessica Blanco
- National Unit of Pediatric Oncology, Guatemala City, Guatemala
| | - Ligia Fu
- Pediatric Hematology and Oncology Unit, Hospital Escuela, Tegucigalpa, Honduras
| | - Darrell Espinoza
- Department of Hematology/Oncology, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua
| | - Elena J. Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY
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Duarte NL, Bueno APS, Sanches BS, Ramos GA, Santos JMBD, Silva HFHE, Pondé JDO, Sá JGD, Rossi PM, Horn PRCB, Sztajnbok DCDN, Rubini NDPM, da Costa ES, Milito CB, de Abreu TF, Land MGP. Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study. Cancers (Basel) 2023; 15:cancers15082292. [PMID: 37190220 DOI: 10.3390/cancers15082292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72-50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02-78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81-12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84-13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76-0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.
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Affiliation(s)
- Nathalia Lopez Duarte
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Ana Paula Silva Bueno
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Bárbara Sarni Sanches
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Gabriella Alves Ramos
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Faculty of Medical Sciences (FCM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Julia Maria Bispo Dos Santos
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Henrique Floriano Hess E Silva
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Janaina de Oliveira Pondé
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - José Gilberto de Sá
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | - Priscila Mazucanti Rossi
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | | | - Denise Cardoso das Neves Sztajnbok
- Pediatric Infectious Diseases Division, Department of Pediatrics, Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Norma de Paula Motta Rubini
- Department of Allergy and Immunology, School of Medicine and Surgery, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil
| | - Elaine Sobral da Costa
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Cristiane Bedran Milito
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Department of Pathology, Faculty of Medicine (FM), Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Thalita Fernandes de Abreu
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Infectious and Parasitic Diseases Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Marcelo Gerardin Poirot Land
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
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Mora DC, Jong MC, Quandt SA, Arcury TA, Kristoffersen AE, Stub T. Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers. BMC Complement Med Ther 2023; 23:104. [PMID: 37013571 PMCID: PMC10069108 DOI: 10.1186/s12906-023-03924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer. METHODS A qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes. RESULTS Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child. CONCLUSIONS Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families.
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Affiliation(s)
- Dana C Mora
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Miek C Jong
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
| | - Trine Stub
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
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Wireko AA, Patel H, Mehta A, Jiffry R, Adebusoye FT, Miteu GD. Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial. Int J Surg 2023; 109:235-238. [PMID: 37093068 PMCID: PMC10389311 DOI: 10.1097/js9.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 04/08/2023]
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Li C, Feng C, Xu R, Jiang B, Li L, He Y, Tu C, Li Z. The emerging applications and advancements of Raman spectroscopy in pediatric cancers. Front Oncol 2023; 13:1044177. [PMID: 36814817 PMCID: PMC9939836 DOI: 10.3389/fonc.2023.1044177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
Although the survival rate of pediatric cancer has significantly improved, it is still an important cause of death among children. New technologies have been developed to improve the diagnosis, treatment, and prognosis of pediatric cancers. Raman spectroscopy (RS) is a non-destructive analytical technique that uses different frequencies of scattering light to characterize biological specimens. It can provide information on biological components, activities, and molecular structures. This review summarizes studies on the potential of RS in pediatric cancers. Currently, studies on the application of RS in pediatric cancers mainly focus on early diagnosis, prognosis prediction, and treatment improvement. The results of these studies showed high accuracy and specificity. In addition, the combination of RS and deep learning is discussed as a future application of RS in pediatric cancer. Studies applying RS in pediatric cancer illustrated good prospects. This review collected and analyzed the potential clinical applications of RS in pediatric cancers.
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Affiliation(s)
- Chenbei Li
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chengyao Feng
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruiling Xu
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Buchan Jiang
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lan Li
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu He
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chao Tu
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Chao Tu, ; Zhihong Li,
| | - Zhihong Li
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Chao Tu, ; Zhihong Li,
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Goangul MS, Stewart WC, Erenso D, Crogman HT. The radiation response measurement of a single and multiple cell ionization of neuroblastoma cells by infrared laser trap. JOURNAL OF RADIATION RESEARCH 2023; 64:113-125. [PMID: 36527720 PMCID: PMC9855329 DOI: 10.1093/jrr/rrac082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Indexed: 06/17/2023]
Abstract
Neuroblastoma (NB) is a common type of cancer found mostly in infants and arising from the immature neural crest cells of the sympathetic nervous system. Using laser trapping (LT) technique, the present work contributes to advancing radiotherapy (RT), a leading treatment method for cancer. A single, 2-cells, 3-cells, 4-cells, and 5-cells were trapped using the high-intensity gradient infrared laser at 1064 nm and allowed to become ionized. In this work, a systematic study of Threshold Ionization Energy (TIE) and Threshold Radiation Dose (TRD) versus mass for both single and multi-cell ionization using laser trapping (LT) techniques on NB is presented. The results show that TIE increased as the mass of cells increased, meanwhile TRD decreased with the increase of cell mass. We observed an inverse correlation between TRD and cell mass. We demonstrate how to compute the maximum radiation dosage for cell death using the LT technique. Results show a possible blueprint for computing the TRD in vivo. The use of multiple cell ionization to determine radiation dosage along with better data accuracy concerning the tumor size and density will have profound implications for radiation dosimetry. The diminution in TRD becomes more significant in multiple cell ionization as we see in TRD vs the number of cells entering the trap. This is due to the chain effect generated by radiation and the absorption by water molecules at 1064 nm. This result provides us with better insight into the optimization of the therapeutic ratio.
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Affiliation(s)
- Mulugeta S Goangul
- Department of Physics, Addis Ababa University, Addis Ababa 1000, Ethiopia
| | - William C Stewart
- Department of Biology, Middle Tennessee State University, Murfreesboro, Tennessee 37132, USA
| | - Daniel Erenso
- Department of Physics and Astronomy, Middle Tennessee State University, Murfreesboro, Tennessee 37132, USA
| | - Horace T Crogman
- Corresponding author. Department of Physics, California State University Dominguez Hills, Carson, California, 90747, USA. Tel: +1-310-243-2092; E-mail:
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Alarjeh G, Boufkhed S, Alrjoub W, Guo P, Yurduşen S, Ahmed F, Abdal-Rahman M, Alajarmeh S, Alnassan A, Al-Awady S, Kutluk T, Harding R, Shamieh O. Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study. Front Oncol 2023; 13:1118992. [PMID: 37182158 PMCID: PMC10172987 DOI: 10.3389/fonc.2023.1118992] [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: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan. Methods A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed. Findings Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers' suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients' and caregivers' health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child's care and prognosis, which posed challenges to communication with staff. Discussion The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children's ability to engage in primary research and to express preferences, and parents' ability to share views on this sensitive topic.
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Affiliation(s)
- Ghadeer Alarjeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
- *Correspondence: Ghadeer Alarjeh, ; Omar Shamieh,
| | - Sabah Boufkhed
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, United Kingdom
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sema Yurduşen
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
- Department of Psychology, Ankara Science University, Ankara, Türkiye
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
- Department of Public Health, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Mousa Abdal-Rahman
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Sawsan Alajarmeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Anwar Alnassan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Shireen Al-Awady
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
- College of Medicine, the University of Jordan, Amman, Jordan
- *Correspondence: Ghadeer Alarjeh, ; Omar Shamieh,
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Chakumatha E, Khofi H, Landman L, Weijers J, Bailey S, Chagaluka G, Molyneux E, Israels T. Towards zero percent treatment abandonment of patients with common and curable childhood cancer types in Blantyre, Malawi. Pediatr Blood Cancer 2022; 69:e29899. [PMID: 35869892 DOI: 10.1002/pbc.29899] [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: 01/05/2022] [Revised: 05/24/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Treatment abandonment is a common cause of treatment failure in low-income countries (LIC). We implemented a comprehensive package of interventions aiming to enable all families to complete the treatment of their child. The objective of this study was to evaluate the impact of those interventions. PROCEDURE In this prospective and historically controlled study, we included all children younger than 16 years with a newly diagnosed common and curable cancer type (acute lymphoblastic leukaemia [ALL], Hodgkin disease, Wilms tumour, retinoblastoma and Burkitt lymphoma) admitted to the Queen Elizabeth Central Hospital in Blantyre, Malawi, between 1 June 1 2019 and 1 June 1 2020. Interventions to enable treatment completion included full funding of costs to the family (treatment, transport, accommodation and food in the hospital) and tracking of patients if they did not attend treatment appointments. The outcomes of patients were compared with those of a similar historical cohort. RESULTS The intervention cohort of 150 patients were compared to 264 historical control patients. Treatment abandonment decreased significantly from 19% (49/264) to 7% (10/150) (p < .001). The proportion of patients with Wilms tumour, retinoblastoma or ALL alive without evidence of disease at the end of treatment increased from 38% (57/149) to 53% (44/83) (p = .03). CONCLUSION A simple and relatively low-cost comprehensive intervention package with no costs for families, significantly decreased treatment abandonment. This strategy may increase survival of children with common and curable cancers in LIC, especially when coupled with improvements in access to treatment and quality of treatment, including supportive care.
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Affiliation(s)
- Eunice Chakumatha
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Harriet Khofi
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lisa Landman
- Academy Outreach and Department of Solid Tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Janna Weijers
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi.,Academy Outreach and Department of Solid Tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Simon Bailey
- Department of Paediatric Oncology, Sir James Spence Institute of Child Health, Royal Victoria Infirmary Queen, Newcastle, UK
| | - George Chagaluka
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Trijn Israels
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi.,Academy Outreach and Department of Solid Tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
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21
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Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania. PLoS One 2022; 17:e0273296. [PMCID: PMC9674137 DOI: 10.1371/journal.pone.0273296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Worldwide, an estimated 400,000 children develop cancer each year. The bulk of the mortalities from these cases occur in low-and-middle-income countries (LMICs). In Sub-Saharan Africa, there is a tremendous need to strengthen the capacity of health systems to provide high-quality cancer care for children. However, a lack of data on the economic impact of cancer treatment in low-resource settings hinders its consideration as a healthcare priority. To address this gap, this study models the clinical and financial impact of pediatric cancer care in Tanzania, a lower-middle income country in East Africa. Methods We conducted a retrospective review of patients with cancer under the age of 19 years treated at Bugando Medical Centre from January 2010 to August 2014. Information was collected from a total of 161 children, including demographics, type of cancer, care received, and five-year survival outcomes. This data was used to calculate the number of averted disability-adjusted life-years (DALYs) with treatment. Charges for all direct medical costs, fixed provider costs, and variable provider costs were used to calculate total cost of care. The societal economic impact of cancer treatment was modeled using the value of statistical life (VSL) and human capital methods. Findings The total health impact for these 161 children was 819 averted DALYs at a total cost of $846,743. The median cost per patient was $5,064 ($4,746–5,501 interquartile range). The societal economic impact of cancer treatment ranged from $590,534 to $3,647,158 using VSL method and $1,776,296 using a human capital approach. Interpretation Despite the limitations of existing treatment capacity, economic modeling demonstrates a positive economic impact from providing pediatric cancer care in Tanzania. As many countries like Tanzania progress towards achieving Universal Health Coverage, these key economic indicators may encourage future investment in comprehensive pediatric cancer care programs in low-resource settings to achieve clinically and economically beneficial results not only for the individual patients, but for the country as a whole.
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22
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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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23
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Cayrol J, Ilbawi A, Sullivan M, Gray A. The development and education of a workforce in childhood cancer services in low- and middle-income countries: a scoping review protocol. Syst Rev 2022; 11:167. [PMID: 35964146 PMCID: PMC9375391 DOI: 10.1186/s13643-022-02040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An estimated 400,000 children develop cancer worldwide. Of those, 90% occur in low- and middle-income countries, where survival rates can be as low as 30%. To reduce the childhood cancer survival gap between high- and low- and middle-income countries (LMIC), the World Health Organization launched the Global Initiative for Childhood Cancer in 2018, to support governments in building sustainable childhood cancer programs, with the aim to increase access and quality of care for children with cancer. Developing a high-quality and trained workforce is key to the success of childhood cancer services, but more information is needed on the interventions used to develop and train a workforce. The objective of this review is to understand the key factors described in the literature in relation to the development and training of a workforce in childhood cancer (defined here as ages 0-19) in LMIC, including challenges, interventions and their outcomes. METHODS We will include sources of evidence that describe the development or training of a childhood cancer workforce in health services that diagnose, refer or treat children and adolescents with cancer, in low- and middle-income countries as defined by the World Bank. The following databases will be searched: OVID Medline, Embase and Pubmed from 2001 to present with no restriction of language. Grey literature searches will also be performed in Proquest Dissertation and Theses, as well as relevant organizations' websites, and conference proceedings will be searched in conference websites. In addition, references lists will be reviewed manually. Two people will screen abstracts and full-texts and extract data. Data will be presented in a table or chart, with an accompanying narrative summary responding to the review questions. A framework synthesis will be conducted: data will be charted against a framework adapted from the 2016 WHO Global Strategy for Human Resources for Heath: Workforce 2030. DISCUSSION This scoping review will allow to map the existing literature on workforce development in LMIC, identify potential interventions and highlight data and knowledge gaps. This constitutes a first step towards adopting successful strategies more broadly, formulating research priorities and developing effective policies and interventions. SYSTEMATIC REVIEW REGISTRATION Open Science Framework osf.io/3mp7n.
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Affiliation(s)
- Julie Cayrol
- The University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia. .,World Health Organization, Geneva, Switzerland.
| | | | - Michael Sullivan
- The University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
| | - Amy Gray
- The University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
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24
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Srinivasan S, Gollamudi VRM, Dhariwal N. Pediatric Acute Myeloid Leukemia in India: A Systematic Review. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1754370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background Lower-middle-income countries face unique problems in the management of pediatric acute myeloid leukemia (AML) due to which the outcomes have not kept pace with developed nations. In India, data on childhood AML is sparsely available, thus making a true assessment of disease trends difficult. The current systematic review was undertaken to assess the outcomes of childhood AML from published literature from India over a period of 10 years (2011–2021).
Materials and Methods A systematic search of MEDLINE, Google Scholar, and SCOPUS was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement from January 1, 2011 to December 31, 2021. In addition, International Society of Pediatric Oncology (SIOP) conference abstracts were also screened for relevant studies on AML from India. This study was registered in PROSPERO (ID42021273218).
Results A total of 1,210 patients from 19 studies were included. Standard 3 + 7 and MRC AML based regimens were commonly adopted regimens for induction. Remission rates varied between 56 and 95%. Overall treatment-related mortality across studies was 23.2% (95% confidence interval [CI]: 10.3–35.9%). The mean incidence of treatment abandonment was 19.3% ( 95% CI: 10.9–27.5%). Event-free survival and overall survival were in the range of 28 to 55% and 15 to 66%, respectively. Hematopoietic stem cell transplantation was performed only on a small subset of patients.
Conclusion Outcomes of pediatric AML in India continue to be suboptimal with high treatment abandonment and toxic deaths. Ensuring uniform access to therapy and supportive care along with a robust social support system would improve outcomes of childhood AML in India.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkata Rama Mohan Gollamudi
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nidhi Dhariwal
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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25
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Huang J, Chan SC, Ngai CH, Lok V, Zhang L, Lucero‐Prisno DE, Xu W, Zheng Z, Elcarte E, Withers M, Wong MCS. Global incidence, mortality and temporal trends of cancer in children: A joinpoint regression analysis. Cancer Med 2022; 12:1903-1911. [PMID: 35822443 PMCID: PMC9883415 DOI: 10.1002/cam4.5009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/METHODS The Cancer Incidence in Five Continents Time Trends, Nordic Cancer Registries, Surveillance, Epidemiology and End Results, WHO Mortality databases were assessed to extract the Age-Standardised Rates (ASR) of cancer incidence and mortality among children aged 0-14 years old. By using the ASRs, the country-specific Average Annual Percentage Change (AAPC) and its corresponding 95% confidence interval (CI) were calculated to determine the epidemiological cancer trend. RESULTS In 2020, the highest incidence of childhood cancer was found in countries with higher Human Development Index (HDI) (ASR = 15.7), yet the highest mortality was found in countries with lower HDIs (ASR = 4.8). As for incidence, seven countries had positive AAPC among boys; Slovakia (AAPC2001-2010 = 4.98, 95% CI [1.66-8.40]), Ecuador (AAPC2003-2012 = 4.07, 95% CI [0.67-7.59]) and Thailand (AAPC2003-2012 = 3.69, 95% CI [0.37-7.11]) had the highest AAPC. Among girls, three countries had positive AAPC, which included Belarus (AAPC2003-2012 = 3.18, 95% CI [1.11, 5.29]), Canada (AAPC2003-2012 = 2.83, 95% CI [1.60, 4.07]) and Korea (AAPC2003-2012 = 1.76, 95% CI [0.23-3.32]). There was an overall decreasing trend of mortality. However, increased mortality was observed in two countries: Ecuador for boys (AAPC2007-2016 = 1.72, 95% CI [0.27-3.19]) and Austria for girls (AAPC2008-2017 = 4.11, 95% CI [0.38-7.98]). CONCLUSIONS The largest mortality and mortality to incidence ratio of childhood cancer were found in low-income countries. There was a substantial increasing trend of childhood cancer incidence, while overall its mortality has been decreasing over the past decade. More studies are needed to confirm the drivers behind these epidemiologic trends.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Chun Ho Ngai
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina
| | - Veeleah Lok
- Department of Global Public Health, Karolinska InstituteKarolinska University HospitalStockholmSweden
| | - Lin Zhang
- School of Population and Global HealthThe University of MelbourneVictoriaAustralia,School of Public HealthThe Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Don Eliseo Lucero‐Prisno
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Wanghong Xu
- School of Public HealthFudan UniversityShanghaiChina
| | - Zhi‐Jie Zheng
- Department of Global Health, School of Public HealthPeking UniversityBeijingChina
| | | | - Mellissa Withers
- Department of Population and Public Health Sciences, Institute for Global HealthUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong KongSARChina,School of Public HealthThe Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina,Department of Global Health, School of Public HealthPeking UniversityBeijingChina
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Roy Moulik N, Bhat V, Yadav R, Narula G, Challinor J, Banavali S. Development and impact of a novel hospital to home-away-from-home infection control outreach nursing program in Mumbai: Tata Memorial Hospital experience. Pediatr Blood Cancer 2022; 69:e29449. [PMID: 34767282 DOI: 10.1002/pbc.29449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Nirmalya Roy Moulik
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vasudeva Bhat
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajeshree Yadav
- Department of Nursing, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Shripad Banavali
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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27
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Kruk ME, Lewis TP, Arsenault C, Bhutta ZA, Irimu G, Jeong J, Lassi ZS, Sawyer SM, Vaivada T, Waiswa P, Yousafzai AK. Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services. Lancet 2022; 399:1830-1844. [PMID: 35489361 PMCID: PMC9077444 DOI: 10.1016/s0140-6736(21)02532-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/10/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health and Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Grace Irimu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Ángela María JU, Mario CF, Mauricio HC, Ana Gisset GP, Jorge Alirio HR, Guillermo PP, Alejandro BC. A cross-sectional study of the socio-demographic and epidemiological factors associated with childhood cancer in Cali, Colombia. Heliyon 2022; 8:e09410. [PMID: 35620634 PMCID: PMC9126933 DOI: 10.1016/j.heliyon.2022.e09410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/09/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
This study investigates the occurrence of childhood cancer between the years 2015 and 2016 in the city of Cali, Colombia, with respect to: a) sociodemographic characteristics, b) type of cancer, c) epidemiological weeks of cancer and d) comparative survival according to health system affiliation by consolidating the records notified to the municipal health secretariat. Statistically significant differences were found between the groups analysed in relation to the variables related to the type of cancer (p = 0.006). With respect to the proportion of cancer mortality between the years 2015–2016 there was no significant change, even though survival increased in the year 2016. The implications for collective health and public policies in Latin America are discussed.
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29
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Mallon B, Kaboré R, Couitchere L, Akonde FB, Lukamba R, Dackono TA, Narison MLR, Khattab M, Pondy A, Fedhila Ben Ayed F, Budiongo A, Guedenon K, Oberlin O, Patte C. The development of an international childhood cancer hospital register database in 13 African countries. A project of the French African Pediatric Oncology Group (GFAOP). Pediatr Blood Cancer 2022; 69:e29464. [PMID: 34913572 DOI: 10.1002/pbc.29464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIM The establishment of an international hospital-based register (HBR) for the French African Pediatric Oncology Group (GFAOP) was a necessary step in the group's clinical research program. With help from the Sanofi Espoir Foundation's "My Child Matters" program, the GFAOP resolved to develop an international HBR network to collect quality data on children attending the Pediatric Oncology Units (POUs). METHODS All children entering POUs from January 2016 to December 2018 were registered using an online questionnaire. Data collection included information on diagnosis, disease stage, demographics, socioeconomic status, and outcome. An intensive training program was developed to improve both data quality and quantity. RESULTS Among the 3348 children registered, 3230 had a suspected cancer, 681 were not confirmed. A diagnosis was confirmed on radiological, clinical, or histological examination for 2549 children including Burkitt lymphoma (516: 20%)-the most frequent diagnosis, Wilms' tumor (459: 18%), retinoblastoma (357: 14%), and acute lymphoblastic leukemia (345: 13%). Of these, 2187 children were treated. Early deaths, abandonment, economic difficulties, and lack of equipment were some of the reasons offered to explain the numbers of undiagnosed and untreated children. Vital status is known for 1994 children: 1187 died and 807 were alive, 551 of these with a follow-up > 12 months. CONCLUSION This work has provided reliable data on children attending the POUs, especially clarifying reasons and occasions for care rupture. The data will help to identify material, human resources, and staff training needs, to evaluate progress, and to encourage consideration of pediatric cancer in national cancer plans.
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Affiliation(s)
| | - Rolande Kaboré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | | | - Robert Lukamba
- Cliniques Universitaires de Lubumbashi (CUL) Democratic Republic of Congo (DRC)
| | | | | | | | - Angèle Pondy
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroon
| | | | | | - Koffi Guedenon
- Unité d'oncologie pédiatrique, CHU Sylvanus Olympio, Lomé, Togo
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30
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Ellis GK, Chapman H, Manda A, Salima A, Itimu S, Banda G, Seguin R, Manda G, Butia M, Huibers M, Ozuah N, Tilly A, Stover AM, Basch E, Gopal S, Reeve BB, Westmoreland KD. Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains. Pediatr Blood Cancer 2021; 68:e29257. [PMID: 34339099 PMCID: PMC8497011 DOI: 10.1002/pbc.29257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient-reportedoutcomes (PROs) that assess health-related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub-Saharan Africa (SSA). METHODS We administered the Chichewa Pediatric Patient-Reported Outcome Measurement Information System Pediatric (PROMIS)-25 at diagnosis, active treatment, and follow-up among pediatric lymphoma patients in Lilongwe, Malawi. Mean scores were calculated for the six PROMIS-25 HRQoL domains (Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, Pain Interference). Differences in HRQoL throughout treatment were compared using the minimally important difference (MID) and an ANOVA analysis. Kaplan-Meier survival estimates and Cox hazard ratios for mortality are reported. RESULTS Seventy-five children completed PROMIS-25 surveys at diagnosis, 35 (47%) during active treatment, and 24 (32%) at follow-up. The majority of patients died (n = 37, 49%) or were lost to follow-up (n = 6, 8%). Most (n = 51, 68%) were male, median age was 10 (interquartile range [IQR] 8-12), 48/73 (66%) presented with advanced stage III/IV, 61 (81%) were diagnosed with Burkitt lymphoma and 14 (19%) Hodgkin lymphoma. At diagnosis, HRQoL was poor across all domains, except for Peer Relationships. Improvements in HRQoL during active treatment and follow-up exceeded the MID. On exploratory analysis, fair-poor PROMIS Mobility <40 and severe Pain Intensity = 10 at diagnosis were associated with increased mortality risk and worse survival, but were not statistically significant. CONCLUSIONS Pediatric lymphoma patients in Malawi present with poor HRQoL that improves throughout treatment and survivorship. Baseline PROMIS scores may provide important prognostic information. PROs offer an opportunity to include patient voices and prioritize holistic patient-centered care in low-resource settings.
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Affiliation(s)
| | - Hutton Chapman
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Salama Itimu
- UNC Project-Malawi, Lilongwe, Malawi
- Texas Children's Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program, Houston, Texas, USA
| | | | | | - Geoffrey Manda
- Texas Children's Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program, Houston, Texas, USA
| | - Mercy Butia
- Texas Children's Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program, Houston, Texas, USA
| | - Minke Huibers
- Texas Children's Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Nmazuo Ozuah
- Texas Children's Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Alyssa Tilly
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ethan Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine D Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, USA
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Malvezzi M, Santucci C, Alicandro G, Carioli G, Boffetta P, Ribeiro KB, Levi F, La Vecchia C, Negri E, Bertuccio P. Childhood cancer mortality trends in the Americas and Australasia: An update to 2017. Cancer 2021; 127:3445-3456. [PMID: 34043810 PMCID: PMC8453533 DOI: 10.1002/cncr.33642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/19/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends. METHODS Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries. RESULTS Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia. CONCLUSIONS Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide. LAY SUMMARY Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.
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Affiliation(s)
- Matteo Malvezzi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Claudia Santucci
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Gianfranco Alicandro
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Greta Carioli
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paolo Boffetta
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew York
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Karina Braga Ribeiro
- Department of Collective HealthFaculdade de Ciências Médicas da Santa Casa de São PauloSão PauloBrazil
- Department of Pediatric OncologyHospital Santa Marcelina/TUCCASão PauloBrazil
| | - Fabio Levi
- Department of Epidemiology and Health Services ResearchCentre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eva Negri
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paola Bertuccio
- Department of Biomedical and Clinical Sciences L. SaccoUniversità degli Studi di MilanoMilanItaly
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Atout MM, Carter B. Communication styles between family carers and children with leukaemia in occupied Palestinian territory. J Child Health Care 2021; 25:427-441. [PMID: 32783747 DOI: 10.1177/1367493520949318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the experience of communication regarding the care of children with cancer, from the perspective of family carers, children and health professionals in occupied Palestinian territory. This study employed an ethnographic collective qualitative case study approach, which was applied in one oncology unit in a Palestinian hospital. Participant observation and semi-structured interviews were used. This study only reports the findings of the interviews with the participating family carers. Fifteen interviews were conducted with family carers (n = 14 children), namely mothers (n = 7), grandmothers (n = 7) and a father (n = 1). The findings reveal that styles of information were given to children by their family carers: minimal/practical information, gradual information, false information, reassuring information and several sources of information. The term cancer was avoided in the discussion of the disease to ameliorate the negative effect of this term, which is considered taboo in the studied culture. Despite the recent trend emphasising the importance of parents communicating openly with their children with cancer, the findings of this study suggest that such open communication is not accepted by all parents. Hence, a case-by-case strategy could be adopted to treat each child in a way that is individual to that child and their culture.
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Affiliation(s)
- Maha M Atout
- Nursing School, 74428Philadelphia University, Jordan
| | - Bernie Carter
- Children's Nursing, Faculty of Health, Social Care and Medicine, 6249Edge Hill University, UK
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Sen A, Chakrabarti P, Baul SN, Talukder AK, Mandal PK, De R, Dutta S, Dolai TK. Challenges in Care of Children with Acute Leukemia in a Government Hospital in India: A Retrospective Analysis. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many children are forced to abandon therapy.
Objective We have explored reasons for treatment abandonment through this study.
Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were included. Patients >18 years of age, having any history of treatment of AL outside our institute, and/or patients with relapsed AL were excluded. The primary outcome of the study was treatment abandonment rate.
Results A total of 710 AL patients were included in the study, average distance traversed to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%, n = 351), followed by >10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%), bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping. Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%).
Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason for this high abandonment, despite good disease prognosis, is a relevant social and health issue, and needs further evaluation. The problems discussed in this study are relevant to lower-income families and areas where health care is not easily accessible. The government agencies, nongovernment organizations and society would need to work together to overcome these issues.
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Affiliation(s)
- Ankita Sen
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Prantar Chakrabarti
- Department of Haematology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Shuvra N. Baul
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Prakas K. Mandal
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Rajib De
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Shyamali Dutta
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Tuphan K. Dolai
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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Anakwenze Akinfenwa CP, Ibraheem A, Nwankwo K, Lasebikan N, Ali-Gombe M, Aliyu UM, Ikhile E, Adegboyega O, Abdullahi A, Klopp AH, Schmeler K, Lin LL, Jhingran A, Page BR, Leng J, Grover S, Ntekim A. Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria. JCO Glob Oncol 2021; 7:1260-1269. [PMID: 34351813 PMCID: PMC8389883 DOI: 10.1200/go.21.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.
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Affiliation(s)
| | - Abiola Ibraheem
- Section of Hematology Oncology, University of Chicago, Chicago, IL
| | - Kenneth Nwankwo
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Nwamaka Lasebikan
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Musa Ali-Gombe
- Radiology Department, Gombe State University, Gombe, Gombe State, Nigeria
| | - Usman Malami Aliyu
- Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Emmanuel Ikhile
- Department of Radiation Oncology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adamu Abdullahi
- Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Ann H Klopp
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Kathleen Schmeler
- Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lilie L Lin
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jim Leng
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-UPENN Partnership, Gaborone, Botswana
| | - Atara Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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van Heerden J, Zaghloul M, Neven A, de Rojas T, Geel J, Patte C, Balagadde-Kambugu J, Hesseling P, Tchintseme F, Bouffet E, Hessissen L. Pediatric Oncology Clinical Trials and Collaborative Research in Africa: Current Landscape and Future Perspectives. JCO Glob Oncol 2021; 6:1264-1275. [PMID: 32762563 PMCID: PMC7456323 DOI: 10.1200/go.20.00159] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Adequate clinical services have yet to be established in the majority of African countries, where childhood cancer survival rates vary from 8.1% to 30.3%. The aim of this review is to describe the landscape of pediatric oncology trials in Africa, identify challenges, and offer future opportunities for research collaborations. METHODS The study includes data from the International Pediatric Oncology Society (SIOP) global mapping survey, meta-research identifying trials in Africa in ClinicalTrials.gov, and a literature overview of publications on the subject of pediatric oncology clinical research supported by expert opinions on the current situation and challenges. RESULTS The SIOP global mapping survey received responses from 47 of 54 African countries, of which 23 have active clinical research programs. A preliminary search of ClinicalTrials.gov showed that only 105 (12.1%) of 868 African oncology studies included children and adolescents. Of these, 53 (50.5%) were interventional trials according to the registry’s classification. The small number of African trials for children and adolescents included palliative care and leukemia trials. In African oncology journals and international pediatric oncology journals, < 1% of the pediatric oncology publications come from Africa. Services and research were strengthened by international collaboration. National studies focused on clinical needs, local challenges, or interventional priorities. Both the literature review and the expert opinions highlight the need to expand clinical research in Africa, despite ongoing regional instability and lack of resources. CONCLUSION While a low number of pediatric clinical treatment trials are open to African children and adolescents, clinical research of high quality is being done in Africa. Several initiatives are stimulating the development of the research capacity across the continent, which should increase the publication output.
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Affiliation(s)
- Jaques van Heerden
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.,Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Mohamed Zaghloul
- Radiation Oncology Department, National Cancer Institute, Cairo University and Children's Cancer Hospital, Cairo, Egypt
| | - Anouk Neven
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda.,Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Teresa de Rojas
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda.,Pediatric OncoGenomics Unit, Pediatric Oncology-Hematology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Catherine Patte
- Franco-African Pediatric Oncology Group and Gustave Roussy Institute, Villejuif, France
| | | | - Peter Hesseling
- Department of Pediatrics and Child Health, Tygerberg Childrens' Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Eric Bouffet
- Pediatric Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Laila Hessissen
- Pediatric Haematology and Oncology Center, University Mohamed V. Rabat, Rabat, Morocco
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Afungchwi GM, Kruger M, Kouya F, Tih P, McCormick P, Pondy-Ongotsoyi AH, Hesseling PB. Two decades of childhood cancer care in Cameroon: 2000-2020. Pediatr Blood Cancer 2021; 68:e28997. [PMID: 33719184 DOI: 10.1002/pbc.28997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
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 abstracts 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.
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Affiliation(s)
- Glenn Mbah Afungchwi
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon.,Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Pius Tih
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | | | - Angele-Hermine Pondy-Ongotsoyi
- Pediatric Hematology/Oncology, Mother and Child Center, Chantal Biya Foundation, Yaounde, Cameroon.,Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Peter B Hesseling
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Rossell N, Olarte-Sierra MF, Challinor J. Survivors of childhood cancer in Latin America: Role of foundations and peer groups in the lack of transition processes to adult long-term follow-up. Cancer Rep (Hoboken) 2021; 5:e1474. [PMID: 34137212 PMCID: PMC9199506 DOI: 10.1002/cnr2.1474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
Background Over the last decade, the population of childhood cancer survivors has rapidly increased in Latin America, opening a long chapter of challenges for healthcare providers in these countries to provide follow‐up and adult care. Aim In the process of exploring childhood cancer parent and patient engagement in resource‐limited settings, we highlight the challenges faced by Latin American survivors from El Salvador, Mexico, and Peru as they transitioned from receiving cancer treatment to life as a cancer survivors. Methods and Results Focus group discussions and interviews were performed as part of a larger qualitative study involving 10 low and middle‐income countries in four continents regarding patient and caregiver engagement in childhood cancer treatment. We present the results of the Latin‐American survivors and their experiences finishing treatment and life outside the pediatric oncology follow‐up system. Themes regarding a) losing eligibility for pediatric surveillance and care, b) the importance of peer survivors, and c) the need for giving back were part of their stories. Conclusion We suggest that given the lack of organized support from healthcare systems and providers for survivors' proper transition into adult‐centered care, foundations and non‐governmental organizations can provide transitional support, offer space for guidance/information, and work towards collaboration among systems for future integrated programs.
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Affiliation(s)
- Nuria Rossell
- Independent Medical Anthropology Researcher, San Salvador, El Salvador
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Fischer AN, Roecker R, Saba da Silva N, Cavalheiro S, Finlay JL, Cappellano A, Osorio DS. Validated quantitative needs assessment differences in the management of children with central nervous system cancer between Brazil, an upper middle-income country, and the United States of America, a high income country. Pediatr Blood Cancer 2021; 68:e28958. [PMID: 33760367 DOI: 10.1002/pbc.28958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric cancer cure rates differ among high-income countries (HIC) and upper middle-income countries (UMIC). We have compared individual capacities of two major referral pediatric centers from a HIC and an UMIC caring for children with central nervous system (CNS) cancer. METHODS A quantitative needs assessment questionnaire and key informant interviews, distributed in March of 2017, were used to evaluate the treatment of children with CNS cancer at Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) children's cancer center in São Paulo, Brazil and Nationwide Children's Hospital (NCH) in Columbus, Ohio, United States of America (USA). RESULTS Both hospitals had 24-hour pediatric oncology, nursing and intensivist coverage. Supportive care available at both institutions included social workers, psychologists, child life specialists, and physical/occupational/speech therapists. Differences included two part-time neuroradiologists and one pathologist specializing in neuropathology at IOP/GRAACC/UNIFESP, whereas eight full-time neuroradiologists and two neuropathologists at NCH/OSU. There were four pediatric neurosurgeons on staff at each hospital; however, there were only 2 operative days per week at IOP/GRAACC/UNIFESP, compared with 7 days at NCH/OSU. Additionally, time to initiation of radiation therapy at IOP/GRAACC/UNIFESP extended 2-4 weeks compared with less than 1 week at NCH/OSU. CONCLUSIONS Center-specific differences in resources exist in highly specialized hospitals caring for children with CNS cancer in HIC and UMIC. This quantitative needs assessment may facilitate the development of targeted strategies for effective interventions to improve on the management of children with CNS cancers.
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Affiliation(s)
- Allison N Fischer
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Roberto Roecker
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | | | - Sergio Cavalheiro
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Jonathan L Finlay
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Andrea Cappellano
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Diana S Osorio
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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Parkin DM, Youlden DR, Chitsike I, Chokunonga E, Couitchéré L, Gnahatin F, Nambooze S, Wabinga H, Aitken JF. Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub-Saharan Africa. Int J Cancer 2021; 148:2685-2691. [PMID: 33433927 DOI: 10.1002/ijc.33468] [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: 09/21/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.
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Affiliation(s)
- Donald Maxwell Parkin
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- African Cancer Registry Network, INCTR, Oxford, UK
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Inam Chitsike
- Paediatric Heme-Oncology Unit, University of Zimbabwe, Harare, Zimbabwe
| | | | - Line Couitchéré
- Pediatric Unit, Teaching Hospital of Treichville, Félix Houphouët Boigny Université, Abidjan, Côte d'Ivoire
| | - Franck Gnahatin
- Registre du Cancer d'Abidjan (RCA), Programme National de Lutte contre le Cancer (PNLCa), Ministère de la Santé et de l'Hygiène Publique (MSHP), Abidjan, Côte d'Ivoire
| | - Sarah Nambooze
- Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery. Pediatr Surg Int 2021; 37:529-537. [PMID: 33399928 DOI: 10.1007/s00383-020-04813-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
About 1.7 billion children and adolescents, mostly in low- and middle-income countries (LMICs) lack access to surgical care. While some of these countries have developed surgical plans and others are in the process of developing theirs, children's surgery has not received the much-needed specific emphasis and focus in these plans. With the significant burden of children's surgical conditions especially in low- and middle-income countries, universal health coverage and the United Nations' (UN) Sustainable Development Goals (SDG) will not be achieved without deliberate efforts to scale up access to children's surgical care. Inclusion of children's surgery in National Surgical Obstetric and Anaesthesia Plans (NSOAPs) can be done using the Global Initiative for Children's Surgery (GICS)-modified Children's Surgical Assessment Tool (CSAT) tool for baseline assessment and the Optimal Resources for Children Surgical Care (OReCS) as a foundational tool for implementation.
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41
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Yang S, Wallach M, Krishna A, Kurmasheva R, Sridhar S. Recent Developments in Nanomedicine for Pediatric Cancer. J Clin Med 2021; 10:1437. [PMID: 33916177 PMCID: PMC8036287 DOI: 10.3390/jcm10071437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Cancer is the second biggest cause of death in children in the US. With the development of chemotherapy, there has been a substantial increase in the overall survival rate in the last 30 years. However, the overall mortality rate in children with cancer remains 25%, and many survivors experience a decline in overall quality of life and long-term adverse effects caused by treatments. Although cancer cells share common characteristics, pediatric cancers are different from adult cancers in their prevalence, mutation load, and drug response. Therefore, there is an urgent unmet need to develop therapeutic approaches specifically designed for children with cancer. Nanotechnology can potentially overcome the deficiencies of conventional methods of administering chemotherapy and ultimately improve clinical outcomes. The nanoparticle-based drug delivery systems can decrease the toxicity of therapy, provide a sustained or controlled drug release, improve the pharmacokinetic properties of loading contents, and achieve a targeted drug delivery with achievable modifications. Furthermore, therapeutic approaches based on combining nanoformulated drugs with novel immunotherapeutic agents are emerging. In this review, we discussed the recently developed nanotechnology-based strategies for treating blood and solid pediatric cancers.
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Affiliation(s)
- Shicheng Yang
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA;
| | - Mia Wallach
- School of Business, Northeastern University, Boston, MA 02115, USA;
| | - Apurva Krishna
- Department of Physics, Northeastern University, Boston, MA 02115, USA;
| | - Raushan Kurmasheva
- Department of Molecular Medicine, The University of Texas Health at San Antonio, San Antonio, TX 78229, USA
- Greehey Children’s Cancer Research Institute, San Antonio, TX 78229, USA
| | - Srinivas Sridhar
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA;
- Department of Physics, Northeastern University, Boston, MA 02115, USA;
- Division of Radiation Oncology, Harvard Medical School, Boston, MA 02115, USA
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42
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Edan C, Yao AJJ, Hessissen L, Moreira C, Viallard ML, Poulain P, Calmanti S, Thinlot C, Aubier F, Douçot MS, Gagnepain-Lacheteau A, Patte C. Integrating a palliative approach into the healthcare provided by the French-African Pediatric Oncology Group's pilot units. Insights from a 3-year training program. Arch Pediatr 2021; 28:166-172. [PMID: 33446430 DOI: 10.1016/j.arcped.2020.12.002] [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: 07/07/2020] [Revised: 09/20/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Working alongside local stakeholders, members of the French-African Pediatric Oncology Group developed a 3-year program to train pediatric oncology teams from 15 French-speaking countries in Africa in using analgesics and providing palliative care. This program was rolled out in three phases: initial training, in situ assessment, and advanced training in selected topics. To access this program, multidisciplinary teams had to come up with a project to improve their existing palliative care and pain management practices, and commit themselves to implementing it. All the teams invited agreed to take part in the program, which explicitly broached a subject that is often avoided in oncology teaching. The first phase was rolled out in 2017, with 65 trainees from 19 units attending one of three sessions held in Dakar, Senegal, Abidjan, Côte d'Ivoire, and Rabat, Morocco. The subsequent assessment revealed that only half the teams had started to implement their projects. The advanced training phase was therefore adjusted accordingly. A collective training session held in Marseille was attended by 15 trainees from seven teams whose projects were already underway, while in situ mentoring was provided for six other teams, through French-African twinnings in four cases. The length and openness of the program meant that we were able to identify and share the units' diverse realities, and fine-tune their projects accordingly, as well as plan ways of continuing the training both locally and collectively.
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Affiliation(s)
- C Edan
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - A J J Yao
- Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - L Hessissen
- Pediatric Oncology Department, Children's Hospital, Rabat, Morocco
| | - C Moreira
- Pediatric Oncology Unit, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M L Viallard
- Department of Perinatal Pain and Palliative Medicine, Necker University Hospital for Sick Children, Paris, France
| | - P Poulain
- Les Ormeaux palliative care unit, Tarbes, France
| | - S Calmanti
- La Brise regional pediatric palliative care team, Brittany, France
| | - C Thinlot
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - F Aubier
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - M S Douçot
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | | | - C Patte
- GFAOP, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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43
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Piñeros M, Mery L, Soerjomataram I, Bray F, Steliarova-Foucher E. Scaling Up the Surveillance of Childhood Cancer: A Global Roadmap. J Natl Cancer Inst 2021; 113:9-15. [PMID: 32433739 PMCID: PMC7781445 DOI: 10.1093/jnci/djaa069] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
The World Health Organization recently launched the Global Initiative for Childhood Cancer aiming to substantially increase survival among children with cancer by 2030. The ultimate goal concerns particularly less developed countries where survival estimates are considerably lower than in high-income countries where children with cancer attain approximately 80% survival. Given the vast gap in high-quality data availability between more and less developed countries, measuring the success of the Global Initiative for Childhood Cancer will also require substantial support to childhood cancer registries to enable them to provide survival data at the population level. Based on our experience acquired at the International Agency for Research on Cancer in global cancer surveillance, we hereby review crucial aspects to consider in the development of childhood cancer registration and present our vision on how the Global Initiative for Cancer Registry Development can accelerate the measurement of the outcome of children with cancer.
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Affiliation(s)
- Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Les Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Anacak Y, Zubizarreta E, Zaghloul M, Laskar S, Alert J, Gondhowiardjo S, Giselvania A, Correa-Villar R, Pedrosa F, Dorj B, Kamer S, Howard SC, Quintana Y, Ribeiro RC, Rosenblatt E, Hopkins K. The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study. Clin Oncol (R Coll Radiol) 2020; 33:e211-e220. [PMID: 33250288 DOI: 10.1016/j.clon.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
AIMS Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' MATERIALS AND METHODS A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. RESULTS Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. CONCLUSIONS Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.
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Affiliation(s)
- Y Anacak
- Ege University School of Medicine, Izmir, Turkey
| | | | - M Zaghloul
- National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt
| | - S Laskar
- Tata Memorial Hospital, Mumbai, India
| | - J Alert
- Instituto de Oncología y Radiobiología, Habana, Cuba
| | - S Gondhowiardjo
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - A Giselvania
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - F Pedrosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - B Dorj
- National Cancer Centre, Ulaanbaatar, Mongolia
| | - S Kamer
- Ege University School of Medicine, Izmir, Turkey
| | - S C Howard
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - R C Ribeiro
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - E Rosenblatt
- International Atomic Energy Agency, Vienna, Austria
| | - K Hopkins
- International Atomic Energy Agency, Vienna, Austria.
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Coppes MJ, Kremer LCM. Surviving Survival-Challenge Accepted: Perspectives on Survivorship in Pediatric Oncology. Pediatr Clin North Am 2020; 67:xix-xxi. [PMID: 33131545 DOI: 10.1016/j.pcl.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Max J Coppes
- University of Nevada Reno School of Medicine, Renown Children's Hospital, 1155 Mill Street, Reno, NV 89502, USA.
| | - Leontine C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands; Department of Pediatrics, University of Amsterdam, Amsterdam, The Netherlands.
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Zabih W, Thota AB, Mbah G, Freccero P, Gupta S, Denburg AE. Interventions to improve early detection of childhood cancer in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2020; 67:e28761. [PMID: 33037867 DOI: 10.1002/pbc.28761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood cancer outcomes in low- and middle-income countries (LMICs) lag behind those in high-income countries (HICs), in part due to late presentation and diagnosis. Though several interventions targeting early detection of childhood cancer have been implemented in LMICs, little is known about their efficacy. METHODS We conducted a systematic review to identify studies describing such interventions. We searched multiple databases from inception to December 4, 2019. Studies were included if they reported on LMIC interventions focused on: (a) training of health care providers on early recognition of childhood cancer, or (ii) public awareness campaigns. We used preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct our review. The risk of bias in nonrandomized studies of interventions (ROBINS-I) checklist was used to assess quality of studies. RESULTS Twelve studies met inclusion criteria (n = 5 full text, n = 7 abstract only). Five studies focused on retinoblastoma only, while the others focused on all types of childhood cancer. The majority studied multiple interventions of which early detection was one component, but reported overall outcomes. All identified studies used pre-post evaluative designs to measure efficacy. Five studies reported statistically significant results postintervention: decrease in extraocular spread of retinoblastoma, decrease in rates of refusal/abandonment of treatment, increase in number of new referrals, increase in knowledge, and an absolute increase in median 5-year survival. Other studies reported improvements without tests of statistical significance. Two studies reported no difference in survival postintervention. The ROBINS-I checklist indicated that all studies were at serious risk of bias. CONCLUSION Though current evidence suggests that LMIC interventions targeting early detection of childhood cancer through health professional training and/or public awareness campaigns may be effective, this evidence is limited and of poor quality. Robust trials or quasi-experimental designs with long-term follow up are needed to identify the most effective interventions. Such studies will facilitate and inform the widespread uptake of early detection interventions across LMIC settings.
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Affiliation(s)
- Weeda Zabih
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anilkrishna B Thota
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Glenn Mbah
- Cameroon Baptist Convention Hospitals, Mbingo, Cameroon
| | | | - Sumit Gupta
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Avram E Denburg
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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47
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Harif M. Addressing inequalities in oncology care for African children. EBioMedicine 2020; 62:103140. [PMID: 33249383 PMCID: PMC7701321 DOI: 10.1016/j.ebiom.2020.103140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mhamed Harif
- Centre Hospitalier Tanger-Tétouan-Al Hoceima (Tangiers), Faculté de médecine et de pharmacie, Casablanca, Morocco.
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Peng L, Yam PPY, Yang LS, Sato S, Li CK, Cheung YT. Neurocognitive impairment in Asian childhood cancer survivors: a systematic review. Cancer Metastasis Rev 2020; 39:27-41. [PMID: 31965433 DOI: 10.1007/s10555-020-09857-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Childhood cancer survivors are at higher risk of developing neurocognitive deficits due to the intensive treatment they received at an early age. Most studies on childhood cancer survivorship have so far focused on the Western populations. Due to the ethnic, genetic, environmental, and cultural differences, clinical data of the Western populations may not be representative of Asian countries. This scoping review systematically summarized the existing clinical evidence of the neurocognitive impairment of Asian childhood cancer survivors. We searched the Embase and Medline databases for studies assessing the neurocognitive functions of survivors in Asia, who were diagnosed with cancer before the age of 19 and completed active treatment. The literature search identified 13 studies involving 2212 participants from five Asian countries: South Korea (n = 4, 30.8%), Taiwan (n = 3, 23.1%), Japan (n = 3, 23.1%), Hong Kong (n = 2, 15.4%), and Thailand (n = 1, 7.7%). The included studies focused on CNS tumors (n = 10, 76.9%), hematological malignancies (n = 7, 53.8%), or heterogeneous cancer diagnoses (n = 3, 23.1%). Collectively, mild-to-moderate impairment in intelligence was observed in 10.0 to 42.8% of survivors, which seemed higher than the reported rate in Western survivors. We speculate that the ethnic and genetic variations in drug responses and susceptibility to adverse chronic toxicities may have contributed to the differences in the prevalence and severity of neurocognitive impairment between these two populations. To better understand the effects of culturally relevant and region-specific environmental risk factors on the post-treatment neurocognitive development in cancer survivors, a holistic approach that addresses the complex interactions between biological, physical, and psychosocial factors is needed. This will aid the development of effective intervention strategies to improve the functional and psychosocial outcomes of cancer survivors in Asian societies.
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Affiliation(s)
- Liwen Peng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, New Territories, Hong Kong
| | - Perri Pui-Yan Yam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, New Territories, Hong Kong
| | - Lok Sum Yang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, New Territories, Hong Kong
| | - Satomi Sato
- Graduate School of Public Health, Faculty of Health and Behavioral Science, St. Luke's International University, Tokyo, Japan
| | - Chi Kong Li
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, New Territories, Hong Kong.
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Childhood cancer in Latin America: from detection to palliative care and survivorship. Cancer Epidemiol 2020; 71:101837. [PMID: 33121936 DOI: 10.1016/j.canep.2020.101837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
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50
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Jastaniah W, Justinia T, Alsaywid B, Alloqmani RM, Alloqmani SM, Alnakhli AT, Alganawi A. Improving access to care for children with cancer through implementation of an electronic referral system (IMPACT): A single-center experience from Saudi Arabia. Pediatr Blood Cancer 2020; 67:e28406. [PMID: 32697039 DOI: 10.1002/pbc.28406] [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: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Delayed access to cancer care has been associated with childhood cancer death. Improving timely access to cancer care is the first important step in the cancer treatment journey. We introduced an electronic referral system (e-RS) to improve timely access to cancer care. This study aimed to assess the impact of implementing an e-RS on timely access to cancer care. METHODS A retrospective cross-sectional study of pediatric oncology patients selected through a consecutive nonprobability sampling technique was performed to determine the turnaround time (TAT) of children with cancer diagnosed 12 months before and after implementation of the e-RS. TAT was defined as time in hours from referral to approval for admission. RESULTS Of the 326 pediatric oncology patients diagnosed between January 2014 and December 2015, 59.9% were male and 40.1% were female. Median age for both sexes was 5.0 years (interquartile range [IQR]: 2.5-9.0 years). Among these, 98.2% were Saudi nationals. Hematological malignancies accounted for 50.6% of referrals and 16.6% had lymphoma. The median TAT of the manual referral system (m-RS) and e-RS was 18 h (IQR: 2-25 h) and 2 h (IQR: 1-16 h; P = .0001), median length of hospital stay during first admission was 11 days versus 9 days (P = .14), and death events occurred in 11 patients versus zero patients referred using the m-RS versus e-RS (P = .003), respectively. CONCLUSION The introduction of an e-RS was associated with more rapid processing of pediatric patients for cancer treatment and fewer patient deaths during the initial evaluation and treatment during that time period.
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Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah, Saudia Arabia.,King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Taghreed Justinia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Health Informatics, College of Public Health & Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Basim Alsaywid
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Riyadh Maneea Alloqmani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Saleh Maneea Alloqmani
- College of Medicine, Department of Pediatrics, Umm Al-Qura University, Makkah, Saudia Arabia
| | | | - Abdualrahman Alganawi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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