Survival from childhood cancers in Eastern Africa: A population‐based registry study

Abstract

Cancers occurring in children in Africa are often underdiagnosed, or at best diagnosed late. As a result, survival is poor, even for cancers considered 'curable'. With limited population-level data, understanding the actual burden and survival from childhood cancers in Africa is difficult. In this study, we aimed at providing survival estimates for the most common types of cancers affecting children aged 0-14 years, in three population-based Eastern African registries; Harare, Zimbabwe (Kaposi sarcoma, Wilms tumour (WT), non-Hodgkin lymphoma (NHL), retinoblastoma, and acute lymphocytic leukaemia (ALL)), Kampala, Uganda (Burkitt lymphoma, Kaposi sarcoma, WT, and retinoblastoma), and Nairobi, Kenya (ALL, retinoblastoma, WT, Burkitt lymphoma, and Hodgkin lymphoma). We included cases diagnosed within the years 1998-2009 and followed up till the end of 2011. We estimated the observed and relative survival at 1, 3, and 5 years after diagnosis. We studied 627 individual patient records. Median follow-up ranged from 2.2 months for children with Kaposi sarcoma in Harare to 30.2 months for children with ALL in Nairobi. The proportion of children lost to follow-up was highest in the first year after diagnosis. In Harare and Kampala, the 5-year relative survival was <46% for all cancer types. The 5-year relative survival was best for children in Nairobi, though with wider confidence intervals. Survival from childhood cancers in Africa is still poor, even for cancers with good prognosis and potential for cure. Supporting cancer detection, treatment, and registration activities could help improve survival chances for children with cancers in Africa.

Genome-wide discovery of somatic coding and noncoding mutations in pediatric endemic and sporadic Burkitt lymphoma

“…5 However, eBL remains fatal for the majority of children in sub-Saharan Africa for many reasons, including diagnosis at an advanced stage, healthcare delivery systems lacking capacity to support intensive chemotherapeutic regimens, and poverty/malnutrition. 3,[6][7][8] Outside of malariaendemic regions, BL cases occur at a 10-fold lower incidence, termed sporadic BL (sBL), and concurrent EBV presence is much lower (10%-30%). 9 The clinical manifestations of sBL differ from eBL, with abdominal and thoracic presentations most common and large facial tumors exceedingly rare.…”

Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

“…In a recent review of cancer registries in selected major urban centers in Zimbabwe, Uganda, and Kenya, WT was the most common solid tumor identified in children and third most common pediatric cancer after leukemia and lymphoma. Survival at one year was only 61%, 39%, and 66% at each respective site [ 4 ]. Five-year survival was 33% and 7.9%, with the rate at the third site unavailable due to all children being lost to follow-up.…”

“…In regions with a high HIV burden, up to 20% of pediatric patients have lost a parent, thus impacting family support and potentially requiring additional intervention to carry a child to completion of therapy [ 26 ]. Post-treatment surveillance of pediatric patients with WT is also difficult; the referral centers in Zimbabwe, Uganda, and Kenya reported lost-to-follow-up rates of 15–43% in the first year after treatment [ 4 ].…”

“…In high-income countries (HICs), several multi-institutional collaborations, including the International Society of Pediatric Oncology (SIOP) and the National Wilms Tumor Study Group (NWTSG; now, the Children’s Oncology Group, COG) have succeeded in raising overall survival for Wilms Tumor (WT) to greater than 90% at five years [ 1 , 2 , 3 ]. In contrast, children with most cancers, and especially WT and other solid malignancies, residing in low- and middle-income countries (LMICs) face persistently high mortality rates [ 4 ]. Recent years have seen increased efforts to improve these alarmingly poor outcomes [ 5 ].…”

Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana

“…The disease is therefore largely restricted to equatorial Africa, where it is often the most common paediatric malignancy. The prognosis is poor, particularly when diagnosis is delayed and only incomplete chemotherapy is administered, which is often the case in the low-income settings where eBL is most common [19].…”