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Ehrlich BS, McNeil MJ, Pham LTD, Chen Y, Rivera J, Acuna C, Sniderman L, Sakaan FM, Aceituno AM, Villegas CA, Force LM, Bolous NS, Wiphatphumiprates PP, Slone JS, Carrillo AK, Gillipelli SR, Duffy C, Arias AV, Devidas M, Rodriguez-Galindo C, Mukkada S, Agulnik A. Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Oncol 2023; 24:967-977. [PMID: 37517410 PMCID: PMC10812862 DOI: 10.1016/s1470-2045(23)00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. METHODS For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). FINDINGS Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). INTERPRETATION Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. FUNDING American Lebanese Syrian Associated Charities and National Cancer Institute.
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Affiliation(s)
- Bella S Ehrlich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Linh T D Pham
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jocelyn Rivera
- Department of Pediatric Emergency Medicine, Hospital Infantil Teletón de Oncología, Querétaro, México
| | - Carlos Acuna
- Department of Pediatric Intensive Care, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Liz Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Firas M Sakaan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Alejandra Mendez Aceituno
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Pediatric Intensive Care Unit, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Cesar A Villegas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jeremy S Slone
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela K Carrillo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Caitlyn Duffy
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Anita V Arias
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
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Agulnik A, Muniz-Talavera H, Pham LTD, Chen Y, Carrillo AK, Cárdenas-Aguirre A, Gonzalez Ruiz A, Garza M, Conde Morelos Zaragoza TM, Soberanis Vasquez DJ, Méndez-Aceituno A, Acuña-Aguirre C, Alfonso-Carreras Y, Alvarez Arellano SY, Andrade Sarmiento LA, Batista R, Blasco Arriaga EE, Calderon P, Chavez Rios M, Costa ME, Díaz-Coronado R, Fing Soto EA, Gómez García WC, Herrera Almanza M, Juarez Tobías MS, León López EM, López Facundo NA, Martinez Soria RA, Miller K, Miralda Méndez ST, Mora Robles LN, Negroe Ocampo NDC, Noriega Acuña B, Osuna Garcia A, Pérez Alvarado CM, Pérez Fermin CK, Pineda Urquilla EE, Portilla Figueroa CA, Ríos Lopez LE, Rivera Mijares J, Soto Chávez V, Suarez Soto JI, Teixeira Costa J, Tejocote Romero I, Villanueva Hoyos EE, Villegas Pacheco M, Devidas M, Rodriguez-Galindo C. Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study. Lancet Oncol 2023; 24:978-988. [PMID: 37433316 PMCID: PMC10727097 DOI: 10.1016/s1470-2045(23)00285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. METHODS Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. FINDINGS Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9-13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10-13) before PEWS implementation and 18 months (16-18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69-0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22-1·43]; p<0·0001), being a teaching hospital (1·18 [1·09-1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21-1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92-0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68-1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97-1·12]; p=0·29). INTERPRETATION PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. FUNDING American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | - Linh T D Pham
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Marcela Garza
- St Jude Children's Research Hospital, Memphis, TN, USA
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- Hospital del Niño "Jose Renan Esquivel", Panama, Panama
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- Hospital del Niño. Sistema integral para el Desarrollo de la Familia (DIF), Pachuca, Mexico
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Le VS, Tran KT, Bui HTP, Le HTT, Nguyen CD, Do DH, Ly HTT, Pham LTD, Dao LTM, Nguyen LT. A Vietnamese human genetic variation database. Hum Mutat 2019; 40:1664-1675. [PMID: 31180159 DOI: 10.1002/humu.23835] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/14/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022]
Abstract
Large scale human genome projects have created tremendous human genome databases for some well-studied populations. Vietnam has about 95 million people (the 14th largest country by population in the world) of which more than 86% are Kinh people. To date, genetic studies for Vietnamese people mostly rely on genetic information from other populations. Building a Vietnamese human genetic variation database is a must for properly interpreting Vietnamese genetic variants. To this end, we sequenced 105 whole genomes and 200 whole exomes of 305 unrelated Kinh Vietnamese (KHV) people. We also included 101 other previously published KHV genomes to build a Vietnamese human genetic variation database of 406 KHV people. The KHV database contains 24.81 million variants (22.47 million single nucleotide polymorphisms (SNPs) and 2.34 million indels) of which 0.71 million variants are novel. It includes more than 99.3% of variants with a frequency of >1% in the KHV population. Noticeably, the KHV database revealed 107 variants reported in the human genome mutation database as pathological mutations with a frequency above 1% in the KHV population. The KHV database (available at https://genomes.vn) would be beneficial for genetic studies and medical applications not only for the Vietnamese population but also for other closely related populations.
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Affiliation(s)
- Vinh S Le
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.,Department of Gene Technology, Vinmec International Hospital Times City, Hanoi, Vietnam.,Faculty of Information Technology, University of Engineering and Technology, Vietnam National University Hanoi, Hanoi, Vietnam
| | - Kien T Tran
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Hoa T P Bui
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.,Department of Gene Technology, Vinmec International Hospital Times City, Hanoi, Vietnam.,School of Environment and Life Science, University of Salford, Manchester, United Kingdom
| | - Huong T T Le
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.,Department of Gene Technology, Vinmec International Hospital Times City, Hanoi, Vietnam
| | - Canh D Nguyen
- Faculty of Information Technology, University of Engineering and Technology, Vietnam National University Hanoi, Hanoi, Vietnam
| | - Duong H Do
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.,Department of Gene Technology, Vinmec International Hospital Times City, Hanoi, Vietnam
| | - Ha T T Ly
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.,Department of Gene Technology, Vinmec International Hospital Times City, Hanoi, Vietnam
| | - Linh T D Pham
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Lan T M Dao
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Liem T Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
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