Evaluating the baseline survival outcomes of the “six Global Initiative for Childhood Cancer index cancers” in Africa

BackgroundThe improvement of childhood cancer outcome is determined by early diagnosis, effective treatment, supportive care, and adequate medical follow‐up. Stage at diagnosis may reflect timeliness of diagnosis, therefore standardized registration of stage is essential for interpretation of regional differences and time trends in survival. Here, we describe the feasibility of implementing the Toronto Childhood Cancer Stage Guidelines (hereafter Toronto Guidelines [TG]) in the hospital‐based cancer registry of the Franco‐African Pediatric Oncology Group (GFAOP), and assess the impact of TG stage on outcome in pediatric oncology units (POUs) in seven low‐ and middle‐income countries in sub‐Saharan Africa (SSA).MethodsAll cancer patients diagnosed before 15 years of age with one of the 15 cancer types defined in TG, resident in one of the participating countries, and attending one of the selected POUs in 2017–2019 were included. Stage was assigned according to TG. Patients were followed‐up for vital status for at least 12 months post diagnosis. Survival at 3, 6, and 12 months was calculated using Kaplan–Meier method and compared between POUs and tumor groups using log‐rank test.ResultsTG stage was assigned to 1772 of 2446 (89%) cases diagnosed with one of 11 cancer types. It was not possible to assign TG stage to acute lymphoblastic leukemia (ALL) and the three types of the central nervous system tumors included in the TG. One‐year overall survival (OS) was 58% [95% confidence interval: 55–60] and varied between POUs. Survival declined with increasing stage for four tumor types and was statistically significant for two.ConclusionExcept for ALL and brain tumors, we demonstrated feasibility of TG implementation for childhood solid cancers in participating POUs in SSA, and provided a baseline assessment of childhood cancer outcomes against which future stage distribution and survival can be measured as timelines of diagnosis improve over time within the GFAOP network.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The feasibility of implementing Toronto childhood cancer stage guidelines and estimating the impact on outcome for childhood cancers in seven pediatric oncology units in sub‐Saharan Africa. A study from the Franco‐African Pediatric Oncology Group

Mallon,

Kaboré,

Couitchere

et al. 2023

“…1,2 Overall survival of WT is greater than 90% in high-income countries, 3 but event-free survival in sub-Saharan Africa, using an intention-to-treat analysis ranges from 11% in Sudan, where there is 89% treatment abandonment, to 49.9%. [4][5][6][7][8][9][10][11][12] Causes of treatment failure include treatment abandonment, treatment-related mortality, and disease-related mortality. Treatment abandonment and death during treatment are frequent causes of treatment failure in low-and middle-income countries (LMICs).…”

Section: Introductionmentioning

confidence: 99%

“…The overall aim of the GICC is to increase survival for childhood cancer to at least 60% worldwide by 2030, with an initial focus on six relatively common and curable “index” childhood cancers, including Wilms tumor (WT) 1,2 . Overall survival of WT is greater than 90% in high‐income countries, 3 but event‐free survival in sub‐Saharan Africa, using an intention‐to‐treat analysis ranges from 11% in Sudan, where there is 89% treatment abandonment, to 49.9% 4–12 …”

Section: Introductionmentioning

confidence: 99%

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub‐Saharan Africa: A report from Wilms Africa—CANCaRe Africa

Atwiine,

Mdoka,

Branchard

et al. 2024

Self Cite

BackgroundThe Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub‐Saharan Africa in two phases. Phase I began with four sites and provided out‐of‐pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I.MethodsWilms Africa Phase I (n = 4 sites; 2014–2018) and Phase II (n = 8 sites; 2021–2022) used adapted treatment protocols. Funding for families’ out‐of‐pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients’ outcome at the end of planned first‐line treatment categorized as treatment abandonment, death during treatment, and disease‐related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites.ResultsWe included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease‐related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar.ConclusionProvision of out‐of‐pocket costs was important to improve patient outcomes at the end of planned first‐line treatment in WT. Prevention of treatment abandonment remains an important challenge.

Effectiveness of a Wilms tumour treatment guideline adapted to local circumstances in sub‐Saharan Africa: A report from Wilms Africa Phase II—CANCaRe Africa

Fufa,

Mdoka,

Ayalew

et al. 2024

BackgroundWilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub‐Saharan Africa.MethodsWilms Africa Phase II used a comprehensive WT treatment protocol in a multi‐centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16 years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022.ResultsWe included 230 WT patients, median age 3 years, 53% male. Median maximum tumour diameter at diagnosis was 13.6 cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two‐year event‐free survival (EFS) was 41.3% ± 3.9% after a median follow‐up of 17 months (range: 1–33 months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two‐year EFS of the 26 patients who received radiotherapy was 64.5% ± 9.7% with no reported disease relapse.ConclusionPatients continue to present late with advanced WT in sub‐Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment‐related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease‐related mortality.