Early death and treatment‐related mortality: A report from SUCCOUR ‐ Supportive Care for Children with Cancer in Africa

Abstract

Background: Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment-related and disease-related causes. To prevent these deaths, it is important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment. Methods:We conducted a multicentre prospective, observational cohort study in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were abstracted in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented. Results:We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment-related cause. Treatment-related mortality of all patients in the first 3 months of treatment was 13% (33/252). Conclusion:Fifteen percent of patients had an early death during treatment and 13% had a treatment-related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.

Treatment abandonment: A report from the collaborative African network for childhood cancer care and research—CANCaRe Africa

“…This study was a component of a larger effort to describe practices and outcomes in supportive care in sub‐Saharan Africa. The results of previous descriptions of fever and neutropenia and treatment‐related mortality have been published 17,18 …”

Conference report on the 14th International Society of Paediatric Oncology African Continental Meeting, 16–18 March 2022, Kampala, Uganda

“…The SUCCOUR Phase II study includes a clinical research and nursing component which aims to improve supportive care and the management of fever and neutropenia by implementing and evaluating a local care pathway. SUCCOUR Phase I reported on treatment-related mortality and demonstrated a high mortality of fever and neutropenia episodes and late start of empiric antibiotics, often without obtaining a blood culture [30,31].…”

Factors influencing treatment decision‐making for cancer patients in low‐ and middle‐income countries: A scoping review

“…Cancer is a leading cause of mortality worldwide; with strengthening and development of health systems, identification and diagnosis of cancers is expected to increase, particularly in low‐ and middle‐income countries where a majority of cancer deaths already occur 5,6,8–10 . Importantly, decisions around pursuit of treatment with curative versus non‐curative intent often arise in low‐ and middle‐income countries, due in part to unique challenges within healthcare systems in resource‐limited settings 5,11–13 . Treatment with non‐curative intent refers to treatment that will not lead to cure, but rather is focused on improving symptoms, quality of life, or prolonging life.…”

“…Treatment with non‐curative intent refers to treatment that will not lead to cure, but rather is focused on improving symptoms, quality of life, or prolonging life. In addition to consideration of the patient's clinical presentation, barriers to treatment with curative intent include inadequate healthcare infrastructure, limited access to care and treatment availability, financial burdens of cancer treatment that drive treatment abandonment, and distrust in the medical system leading to pursuit of traditional medicine 5,11–13 . Despite unique challenges to care, physicians who treat cancer in these settings frequently rely on standardized treatment regimens or protocols to guide therapy for patients; many such regimens center on evidence from therapies developed, delivered, and investigated in HICs 5,8,14 …”

“…In addition to consideration of the patient's clinical presentation, barriers to treatment with curative intent include inadequate healthcare infrastructure, limited access to care and treatment availability, financial burdens of cancer treatment that drive treatment abandonment, and distrust in the medical system leading to pursuit of traditional medicine. 5,[11][12][13] Despite unique challenges to care, physicians who treat cancer in these settings frequently rely on standardized treatment regimens or protocols to guide therapy for patients; many such regimens center on evidence from therapies developed, delivered, and investigated in HICs. 5,8,14 To address this limitation, adapted treatment regimens have been developed to stratify cancer-directed therapy recommendations based on locally available infrastructure and resources.…”