Abstract 101: The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania

Abstract

Purpose: In sub-Saharan Africa, cancer treatment facilities are often scarce and centered in urban areas, which means many patients must travel long distances to reach cancer care. Still, little is known about how this distribution of cancer centers impacts patients' ability to access care. Methods: Records of all pediatric patients (<18yo) treated for cancer in Tanzania in 2019 through the Tanzanian Pediatric Cancer Network were reviewed. This network represents all 9 hospitals currently treating children with cancer in Tanzania. Demographic and diagnostic information was recorded. ArcGIS was used to estimate patients' travel times from home addresses to cancer care. AccessMod was used to calculate 4-hour access for the population. Results: In 2019, a total of 821 pediatric patients were diagnosed with cancer with an incidence of 1.42/100,000 population. The most common diagnoses were Wilms tumor (17.2%, n=134), retinoblastoma (16.8%, n=131), and acute lymphoblastic leukemia (15.9%, n=124). There was regional variation by diagnosis, with the Lake Zone having the highest incidence of Burkitt lymphoma (0.29; average 0.15) and retinoblastoma (0.5; average 0.33). Reported regional incidence inversely correlated to distance to cancer treatment facility. Median travel time to cancer care for patients was 4.55 hours. Currently 74.5% of the population lives within 4 hours of existing cancer care facilities, and it would require adding cancer care capacity to 8 additional facilities to reach 95% coverage. Conclusions: This is the first comprehensive evaluation of the incidence of presenting pediatric cancer patients in Tanzania. Only 18.8% of the estimated pediatric patients with cancer in Tanzania were treated in 2019. The reported incidence was lower in areas further away from treatment centers, suggesting the importance of increased access to cancer care facilities as part of a future national scale-up strategy. Citation Format: Luke Maillie, Alice Mutagonda, Lulu Chirande, Laiti Rehema, Shakilu Jumanne, Elton Meleki, Furaha Serventi, Julius Alloyce, Franco Afyusisye, Sebastian Sanchez, Matthew Sisk, Marie Jose Voeten, Ester Kawira, Heronima Joas, Trish Scanlan, Kristin Schroeder. The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 101.

Childhood deprivation and Health related quality of life and associated factors among Pediatric cancer patients at National Hospital, Tanzania

“…Pediatric cancer patients were treated in more than 4 hospitals seeking treatment while the cancer symptoms were prediagnosis, with the majority of them, referred to MNH for diagnosis confirmation and treatment, resulting in late diagnosis and treatment as most of them took more than 2 weeks to arrive at the treatment center. This finding, also shown in previous studies, showed that about 74.5% of pediatric cancer patients live more than 4 hours to reach the cancer centers [11]. This is one of the factors contributing to being late in diagnosis, delaying cancer treatment can lead to early cancer complications, and early infant mortality since most pediatric cancer patients came from disadvantaged areas.…”

“…Hence if the problem is left unattended, increases long-term effects and mortality. Furthermore, most of the previous studies have been conducted to establish the prevalence, incidence, needs, and concerns of childhood cancer [3,9,11,29] They helped to expose early, late and long-term effects of cancer treatment, risk of secondary malignancies, to risk of recurrence and also they confront many issues during the treatment period [30], which include childhood deprivation and social problems. Furthermore, their experience has been associated with an increased risk of detrimental psychosocial effects impacting emotional health, socialization, educational and vocational achievement, and health care access [31].…”

“…In Tanzania, 18.8% of pediatric cancer patients were diagnosed in 2019, with an incidence of 1.42/100,000 whereby Wilms tumor was 17.2%, retinoblastoma 16.8%, and acute lymphoblastic leukemia was 15.9%, furthermore, Burkett lymphoma and Wilm's tumor has been presented mostly in lake zone region [11]. The World Health Organization has launched the Global Initiative for Childhood Cancer (GICC) to maximize the survival rate by up to 60% by 2030, worldwide [12].…”

“…However, there is limited published data about childhood deprivation in pediatric cancer patients worldwide, few studies reveal that in pediatric cancer patients living in the most deprived areas at diagnosis [14], and associated with poor quality of life. Furthermore, evidence shows that most pediatric patients who were diagnosed with cancer disease are hard to reach cancer treatment centers early as they should travel a long distance for care [11].…”

“…Hence if the problem is left unattended, increases long-term effects and mortality. Furthermore, most of the previous studies have been conducted to establish the prevalence, incidence, needs, and concerns of childhood cancer [3,9,11,29].…”