Interventions to improve early detection of childhood cancer in low‐ and middle‐income countries: A systematic review

Abstract

Background: Childhood cancer outcomes in low-and middle-income countries (LMICs) lag behind those in high-income countries (HICs), in part due to late presentation and diagnosis. Though several interventions targeting early detection of childhood cancer have been implemented in LMICs, little is known about their efficacy. Methods: We conducted a systematic review to identify studies describing such interventions. We searched multiple databases from inception to December 4, 2019. Studies were included if they reported on LMIC interventions focused on: (a) training of health care providers on early recognition of childhood cancer, or (ii) public awareness campaigns. We used preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines to conduct our review. The risk of bias in nonrandomized studies of interventions (ROBINS-I) checklist was used to assess quality of studies. Results: Twelve studies met inclusion criteria (n = 5 full text, n = 7 abstract only). Five studies focused on retinoblastoma only, while the others focused on all types of childhood cancer. The majority studied multiple interventions of which early detection was one component, but reported overall outcomes. All identified studies used pre-post evaluative designs to measure efficacy. Five studies reported statistically significant results postintervention: decrease in extraocular spread of retinoblastoma, decrease in rates of refusal/abandonment of treatment, increase in number of new referrals, increase in knowledge, and an absolute increase in median 5-year survival. Other studies reported improvements without tests of statistical significance. Two studies reported no difference in survival postintervention. The ROBINS-I checklist indicated that all studies were at serious risk of bias. Conclusion: Though current evidence suggests that LMIC interventions targeting early detection of childhood cancer through health professional training and/or public awareness campaigns may be effective, this evidence is limited and of poor quality. Robust trials or quasi-experimental designs with long-term follow up are needed to identify the most effective interventions. Such studies will facilitate and inform the widespread uptake of early detection interventions across LMIC settings.

Evaluation of a Health Care Worker Training Intervention to Improve the Early Diagnosis and Referral of Childhood Cancers in Ghana: A Qualitative Descriptive Study

“…Across LMICs, a few HCW-focused training interventions aimed at improving pediatric cancer early recognition and referrals have been implemented, as documented in a recent systematic review. 24 Although some of these studies report important quantitative metrics such as increases in knowledge after intervention and increased number of referral and diagnosis, 21,[25][26][27] a detailed evaluation of these HCW-focused training interventions has been lacking. Our study addresses this research gap by providing information on the range of factors that should be considered when implementing a training intervention in an LMIC context, to ensure that the intervention achieves its desired impacts.…”

Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups

“…Some investigations addressed, in part, economic consequences for the society, such as the loss of the workforce and the costs for outcomes (rehabilitation, long-term complications, survivorship issues, etc.). For example, the costs and cost-effectiveness of treating childhood cancers in LMICs [17] in terms of disability-adjusted life years (DALY), survival and countryspecific life expectancy were recently compared with GDP products using the Consolidated Health Economic Evaluation Reporting Standards, although the identified body of evidence for these countries was still low and had high risks of bias, and true treatment costs were likely underestimated, Fung et al [17] and Zabih et al [18] concluded that overall childhood cancer treatment appears to be clinically effective and cost effective in LMICs, making sufficient cancer care achievable for these patients. Economic hardship reported by a third of families, including an inability to pay drugs (45%), mortgages (18%), utilities (12%); 28% taking personal loans; 20% selling assets.…”

Determining the cost and cost-effectiveness of childhood cancer treatment in Haiti

“…Accordingly, scale-up strategies are necessary to diagnose and treat these additional patients. Although no effective interventions for the early diagnosis of children have been reported [ 22 ], several work streams could be prioritised such as conducting targeted awareness campaigns, improving referral pathways, mitigating financial hardships, establishing follow-up mechanisms to minimise abandonment and capacity building on both the facility and the personnel levels. Additionally, diagnosing more patients will be associated with higher upfront costs, to establish facilities, train and hire personnel and procure additional medicines and supplies.…”