Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt

Abstract

Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0‐18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt‐(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5‐year overall survival (OS) for 14 808 eligible patients using Kaplan‐Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age‐standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five‐year OS was 72.1% (95% CI 71.3‐72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P < .001) and by calendar periods from 69.6% to 74.2% (P < .0001) between 2007‐2012 and 2013‐2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P < .001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high‐income countries. We provide evidence‐based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.

Childhood cancer hospital resource utilization and costs in Egypt, 2013‐2017; patterns, trends, and associated factors for 8886 patients from Children's Cancer Hospital, Egypt

“…In our cohort, adolescents (15‐18 years) had higher costs compared with younger children (0‐14 years), unlike what is reported by other studies, 3,40 because we treat adolescents on the same pediatric protocols, but they receive higher drug doses incurring higher costs. Also, patients who died had lower costs than those who survived, which is opposite to the literature, 1,3,5,23,41 This is likely due to higher early deaths at CCHE as a result of late presentation 13 …”

“…Our fever neutropenia guidelines follow empirical combination of antibiotics, then deescalation (rather than monotherapy and escalation) due to high rates of multidrug resistance (guidelines in Supporting Information Table S2). Treatment‐related mortality (TRM) ranges from 3% in renal tumors to 23.3% in AML 13 …”

“…Egypt has the second‐highest estimated number of incident childhood cancer cases in the WHO Eastern Mediterranean Region , as reported by GLOBOCAN 2020 12 . There exist significant barriers to optimal childhood cancer care in Egypt due to great need and demand for services, inferior outcomes, and limited resources 13 . Thus, there is a need for better targeting of resources and managing costs efficiently in Egypt, to improve care and outcomes effectively as part of the WHO Global Initiative for Childhood Cancers (GICC).…”

Intelligent Segmentation Medical Assistance System for MRI Images of Osteosarcoma in Developing Countries

“…Most developing countries have encountered obstacles in the diagnosis, treatment, and prognosis of osteosarcoma due to the general imperfect medical system. The developing countries are economically backward, and medical resources are in short supply [ 5 – 8 ]. The high-priced magnetic resonance imaging equipment and the lack of professional talents make the early diagnosis of osteosarcoma very difficult [ 9 – 11 ].…”

A medical assistant segmentation method for MRI images of osteosarcoma based on DecoupleSegNet

“…Developing countries have relatively backward economies, tighter medical resources, and less capital investment. [6][7][8][9][10] The instrument used to diagnose osteosarcoma are expensive and energyconsuming, which means most hospitals in these developing countries cannot afford the expenses of instruments. It results in increased pressure on disease diagnosis.…”