Wilms tumor: Experience of a hospital in southern Brazil

Abstract

Death is closely related to late diagnosis in WT. Oncologic services should also be concerned about morbidity caused by therapeutic options in cases of late diagnosis, and the consequences for quality of life.

Continuing barriers to care of Wilms tumor in a low‐income country

“…Of significance in this study is the 73.7% survival among those who completed the available treatment, viz., surgery and prescribed chemotherapy. Though this figure is less than the reported >90% among patients who completed standard treatment from more developed countries and some developing countries, it may be due to the lack of radiotherapy treatment and high proportion of anaplasia in our cases. Also, 83% survival of our cases with stage 2 disease, where the need for complex supportive care is minimal, may compare with the global result.…”

“…This is evidenced by the long duration of symptoms before presentation, absence of stage 1 disease in all of our series, and more than 80% of our cases with advanced disease at presentation. Though similar delayed presentation has been reported in some other developing countries, it contrasts sharply with the situation in more developed countries where most patients have early disease at presentation . Late presentation is associated with complications of the disease, and coupled with the coexisting morbidities in our setting will require more intensive care, which unfortunately is also lacking.…”

Wilms tumor in Africa: A systematic review of management challenges and outcome in two decades (2000‐2019)

“…Though the included studies did not indicate the reason for this, it may be related to the health‐seeking behavior of the region and the reported improvement of access to health care, which might encourage the patients to present earlier 30 . Despite this, with the pooled data the proportion of cases with advanced disease, average size of tumors, and the cases with anaplasia may be similar to the findings from other LMICs, 36–38 but they are still higher than the figures from HICs and the global benchmark 1,34,40,41 . Persisting large proportion of advanced disease at presentation, large tumor weight, and anaplasia cases may be due to the lingering challenge of delayed presentation of most cases in Africa 1–3,7,13 as well as the reported tendency of African WT to express markers of adverse clinical behavior and treatment resistance 42 …”

“…Current evidence indicates that this WT success is commonly associated with HICs where studies have shown a significant reduction of the barriers to WT management in the last century 1,2,34,35 . This contrasts nonetheless with the finding of poorer outcome in many low‐ and middle‐income countries (LMICs) in Africa 2,3,7–9,15,20–22 and outside of Africa 1,4,36–38 due to some persistent patient‐related, socioeconomic, and institutional factors.…”

“…Interestingly, in addition to these two major protocols, some studies have suggested development of a different treatment protocol for African cases that will rely on risk‐based classification in this setting as well as incorporate observed deficiencies in facilities, drug supply, and available supportive care 5,8,20,43,45 . As laudable as this suggestion might seem, it should be designed to address the challenge of failure of completion of planned treatment as available evidence show that treatment protocol notwithstanding, more than 40% of the cases, for undocumented reasons, do not complete planned treatment (Table 3), a feature seen also in other LMICs 34–38 …”