Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Abstract

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.

Working Together to Build a Better Future for Children With Cancer in Africa

“… 8 Two-year event-free survival was 49.9% ± 3.8% in this patient cohort when abandonment of treatment was considered an event. 9 The Collaborative Wilms Tumor Africa Project Phase II is planned to start in the second half of 2020 and aims to improve survival further. There are minor revisions to the comprehensive adapted treatment guide-line based on lessons learned in Phase I.…”

“…After establishing, implementing, and evaluating initial treatment guidelines, we analyzed clinical data and recognized that the major barrier to using more intensive treatment regimens was the lack of optimal supportive care. 9 In 2019, Supportive Care for Children With Cancer in Africa (SUCCOUR) was initiated, with a goal to improve supportive care and reduce treatment-related mortality further. Building on the regional network of the Collaborative Wilms Tumor Africa Project and the lessons learned, SUCCOUR aims to promote improvements in supportive care for every child in Africa to be able to be cured from cancer.…”

Improved outcome after Wilms tumor treatment in Sudan: a 10-year single-center experience

“…Close Follow-up, including home visits when needed, might reduce this problem 21 . Chagaluka et al 22 found that funds used to cover treatment, travel, and other associated costs for patients, significantly reduced the abandonment rate. In our setting, a different approach to minimize abandonment might be more useful.…”

Wilms Tumor in Sub-Saharan Africa: Molecular and Social Determinants of a Global Pediatric Health Disparity

“…Using this multi-center regional collaborative network, program implementation was associated with significantly higher survival without evidence of disease at the end of treatment compared to baseline evaluations (68.5% vs. 52%) (26)(27)(28). Financial support for medical treatment was highlighted as a key strategy to decrease abandonment of treatment (28). In the first multicenter prospective study in sub-Saharan Africa, seven units participated from Senegal, Madagascar, Cameroon, Cote d'Ivoire, Mali, Togo, and Burkina Faso.…”

“…The principal aim was to decrease abandonment of treatment and to improve outcomes (26). Using this multi-center regional collaborative network, program implementation was associated with significantly higher survival without evidence of disease at the end of treatment compared to baseline evaluations (68.5% vs. 52%) (26)(27)(28). Financial support for medical treatment was highlighted as a key strategy to decrease abandonment of treatment (28).…”