Improved outcome at end of treatment in the collaborative Wilms tumour Africa project

Israëls, Trijn; Paintsil, Vivian; Nyirenda, D.; Kouya, Francine; Afungchwi, Glenn Mbah; Hesseling, Peter; Tump, Clara; Kaspers, Gertjan J. L.; Burns, Liz; Arora, Ramandeep Singh; Chagaluka, George; Nana, Philippa; Renner, Lorna; Molyneux, Elizabeth

doi:10.1002/pbc.26945

Cited by 34 publications

(51 citation statements)

References 22 publications

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“…Only treatment outcome could be abstracted and not demographic details or other outcomes due to resource constraints. These outcomes have been reported previously 8,9 . Statistical analysis was performed using SPSS 22.0.…”

Section: Methodsmentioning

confidence: 88%

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Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Chagaluka

Paintsil

Renner

et al. 2020

Pediatric Blood & Cancer

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Introduction The Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub‐Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event‐free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation. Methods The Collaborative WT Africa Project is a multi‐centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described. Results In total, 201 WT patients were included. Two‐year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. Programme implementation was associated with significantly higher survival without evidence of disease at the end of treatment (52% vs 68.5%, P = .002), significantly reduced abandonment of treatment (23% vs 12%, P = .009) and fewer deaths during treatment (21% vs 13%, P = .06). Conclusion This collaborative implementation of an adapted WT treatment guideline, using relatively simple and low‐cost interventions, was feasible. Two‐year EFS was almost 50%. In addition, a significant decrease in treatment abandonment and an increase in survival at the end of treatment were observed compared to a pre‐implementation cohort. Future work should focus on decreasing deaths during treatment and will include enhancing supportive care.

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Section: Methodsmentioning

confidence: 88%

“…Those with histological findings incompatible with WT were excluded as were those with bilateral WT. A detailed description of the adapted WT treatment guideline is reported elsewhere 6,8 . All patients had plain chest radiography and ultrasound of the abdomen to document tumour size and the presence of metastases.…”

Section: Methodsmentioning

confidence: 99%

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Chagaluka

Paintsil

Renner

et al. 2020

Pediatric Blood & Cancer

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“…After adjusting for duplicates, 2001 studies remained. Of these, 30 studies met full inclusion criteria 16–18 29–55. The kappa measure of agreement between the two reviewers was 0.71 (95% CI 0.55 to 0.86).…”

Section: Resultsmentioning

confidence: 99%

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

et al. 2019

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IntroductionA major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic review to synthesise existing evidence on the costs and cost-effectiveness of treating childhood cancers in LMICs.MethodsWe searched multiple databases from their inception to March 2019. All studies reporting costs or cost-effectiveness of treating any childhood cancer in an LMIC were included. We appraised included articles using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Where possible, we extracted or calculated the cost per disability-adjusted life year (DALY) averted using reported survival and country-specific life expectancy. Cost/DALY averted was compared with per capita gross domestic product (GDP) as per WHO-Choosing Interventions that are Cost-Effective guidelines to determine cost-effectiveness.ResultsOf 2802 studies identified, 30 met inclusion criteria. Studies represented 22 countries and nine different malignancies. The most commonly studied cancers were acute lymphoblastic leukaemia (n=10), Burkitt lymphoma (n=4) and Wilms tumour (n=3). The median CHEERS checklist score was 18 of 24. Many studies omitted key cost inputs. Notably, only 11 studies included healthcare worker salaries. Cost/DALY averted was extracted or calculated for 12 studies and ranged from US$22 to US$4475, although the lower-end costs were primarily from studies that omitted key cost components. In all 12, cost/DALY averted through treatment was substantially less than country per capita GDP, and therefore considered very cost-effective.ConclusionMany included studies did not account for key cost inputs, thus underestimating true treatment costs. Costs/DALY averted were nonetheless substantially lower than per capita GDP, suggesting that even if all relevant inputs are included, LMIC childhood cancer treatment is consistently very cost-effective. While additional rigorous economic evaluations are required, our results can inform the development of LMIC national childhood cancer strategies.

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“…Such experiences demonstrate the complexities of treating children with BL and other cancers in LMIC. Efforts to improve curative regimens will require the concurrent development of programs, such as the BL Project, addressing supportive care and resource‐ and risk‐adapted chemotherapy regimens …”

Section: Discussionmentioning

confidence: 99%

“…Efforts to improve curative regimens will require the concurrent development of programs, such as the BL Project, addressing supportive care and resource-and risk-adapted chemotherapy regimens. 32,33…”

Section: Discussionmentioning

confidence: 99%

Survival of children with endemic Burkitt lymphoma in a prospective clinical care project in Uganda

McGoldrick

Mutyaba

Adams

et al. 2019

Pediatric Blood & Cancer

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Purpose “Endemic” Burkitt lymphoma (BL) is a common childhood cancer in Africa. Social and treatment factors may contribute to poor survival. With the aim of improving BL outcomes in Uganda, we undertook a comprehensive project (BL Project) that provided diagnostic support, access to standard chemotherapy, nutritional evaluations, and case management. We evaluated survival of children with BL in the context of the project. Patients and methods Patients followed by the BL Project who consented to research were enrolled in this study. Children with a pathology diagnosis consistent with BL were eligible. Data were collected prospectively. First‐line chemotherapy generally consisted of six cycles of cyclophosphamide, vincristine, low‐dose methotrexate (COM). We used Kaplan–Meier and Cox regression analyses to evaluate factors associated with overall survival (OS). Results Between July 2012 and June 2017, 341 patients with suspected BL presented to the BL Project. One hundred eighty patients with a pathology‐based diagnosis were included in this study. The median age was seven years (interquartile range, 5–9), 74% lived ≥100 km from the Uganda Cancer Institute, 61% had late‐stage disease, 84% had ECOG performance status < 3, 63% reported B‐symptoms, and 22% showed neurologic symptoms. Fewer than 10% abandoned therapy. The four‐year OS rate was 44% (95% CI, 36%–53%). In a multivariate model, ECOG status was significantly associated with mortality. Conclusion The BL Project reduced effects of lacking supportive care and oncology resources, and allowed patients from Uganda to receive curative intent therapy with minimal loss to follow‐up. Nonetheless, OS remains unacceptably low. Improved therapeutic approaches to endemic BL are urgently needed in Africa.

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Improved outcome at end of treatment in the collaborative Wilms tumour Africa project

Abstract: This collaboration, using relatively simple and low-cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment.

Cited by 34 publications

References 22 publications

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

Survival of children with endemic Burkitt lymphoma in a prospective clinical care project in Uganda

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