Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis

Ehrlich, Bella; McNeil, Michael J.; Pham, Linh T D; Chen, Yi‐Chen; Rivera, Jocelyn; Acuña, Carlos; Sniderman, Liz; Sakaan, Firas; Aceituno, Alejandra Méndez; Villegas, César; Force, Lisa M.; Bolous, Nancy S.; Wiphatphumiprates, Parima P; Slone, Jeremy S.; Carrillo, Angela K.; Gillipelli, Srinithya R.; Duffy, Caitlyn; Arias, A.; Devidas, Meenakshi; Rodríguez‐Galindo, Carlos; Mukkada, Sheena; Agulnik, Asya

doi:10.1016/s1470-2045(23)00318-2

Cited by 8 publications

(4 citation statements)

References 53 publications

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“…TRMs are more common in haematological malignancies and are much higher in LMICs with suboptimal supportive care [ 28 , 29 ]. A systematic literature review representing 68,351 childhood cancer patients treated in LMICs concluded that TRM accounted for 30.9% of overall mortality, with trends improving with time in upper-middle income countries but remaining unchanged in low-income and lower-middle-income countries [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

An overview of childhood cancer care and outcomes in Egypt: a narrative review

Soliman,

Bolous,

Heneghan

et al. 2024

ecancer Journal

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Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children’s Cancer Hospital Egypt–57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.

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Section: Resultsmentioning

confidence: 99%

An overview of childhood cancer care and outcomes in Egypt: a narrative review

Soliman,

Bolous,

Heneghan

et al. 2024

ecancer Journal

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“…Children with advanced central nervous system tumors and relapsed or metastatic solid tumors who receive intensive multimodal treatments have poor survival, which has been largely unchanged (25,26). Moreover, intensive chemotherapy may lead to severe toxicity or even fatal events in children who are already clinically compromised and therefore less able to tolerate treatment (4,27).…”

Section: Discussionmentioning

confidence: 99%

“…Important risk factors for avoidable deaths include Rev Panam Salud Publica 48, 2024 | https://journal.paho.org | https://doi.org/10.26633/RPSP.2024. 48 adverse events related to treatment severely impact children's lives (4). Specifically, children from low-and middle-income countries (LMICs), such as some Latin American countries, often present with malnutrition, which affects their ability to tolerate intensive treatment and chemotherapy, ultimately undermining their clinical response (5).…”

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confidence: 99%

The importance of basic and translational research in caring for children with malignant solid tumors in Latin America

Cancela,

Dinardi,

Aschero

et al. 2024

Revista Panamericana De Salud Pública

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Objective. Basic and translational research in pediatric cancer are essential to improve patient care. To critically assess the developments achieved in these areas in Latin America, we systematically reviewed information published between 2013 and 2023. Methods. Studies of basic and translational research performed by investigators in Latin America evaluating pediatric malignant solid and central nervous system tumors were retrieved from PubMed. Original articles published in English between 2013 and 2023 were included. Collaborations among Latin American authors or among Latin American authors working with researchers from other continents were also included. Studies were excluded if they focused only on adults or on basic research in tumor biology not specifically related to the tumor types analyzed in this review. Results. A total of 550 articles were retrieved, but after removal of duplicates, 514 articles were included in the analysis, the majority of which were authored by researchers affiliated with institutions in Argentina, Brazil and Mexico. These countries also had the highest number of collaborations on original articles published with authors from Europe and North America. Argentina had the highest number of collaborations on original publications, with coauthors from Brazil and Uruguay. The median impact factor of the 244 journals in which articles were published was 3.5. The most commonly studied tumors were osteosarcomas, neuroblastomas and medulloblastomas; the most commonly studied areas were molecular analysis, tumor cell biology and biomarkers. Conclusions. In Latin America, research in pediatric oncology is on the agenda, despite a notable disparity in publication rates and frequency of collaboration between countries. There is a need to strengthen scientific collaboration within Latin America and with countries from other continents to promote research and to develop novel treatment strategies that reflect the local needs of children in Latin America who have solid tumors and brain cancer.

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“…Causes of treatment failure include treatment abandonment, treatment‐related mortality, and disease‐related mortality. Treatment abandonment and death during treatment are frequent causes of treatment failure in low‐ and middle‐income countries (LMICs) 13,14 . Documentation of patients’ outcome at the end of planned first‐line treatment provides full information on treatment abandonment and nearly complete information on treatment‐related mortality 15,16 …”

Section: Introductionmentioning

confidence: 99%

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub‐Saharan Africa: A report from Wilms Africa—CANCaRe Africa

Atwiine,

Mdoka,

Branchard

et al. 2024

Pediatric Blood & Cancer

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BackgroundThe Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub‐Saharan Africa in two phases. Phase I began with four sites and provided out‐of‐pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I.MethodsWilms Africa Phase I (n = 4 sites; 2014–2018) and Phase II (n = 8 sites; 2021–2022) used adapted treatment protocols. Funding for families’ out‐of‐pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients’ outcome at the end of planned first‐line treatment categorized as treatment abandonment, death during treatment, and disease‐related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites.ResultsWe included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease‐related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar.ConclusionProvision of out‐of‐pocket costs was important to improve patient outcomes at the end of planned first‐line treatment in WT. Prevention of treatment abandonment remains an important challenge.

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Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis

Cited by 8 publications

References 53 publications

An overview of childhood cancer care and outcomes in Egypt: a narrative review

An overview of childhood cancer care and outcomes in Egypt: a narrative review

The importance of basic and translational research in caring for children with malignant solid tumors in Latin America

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub‐Saharan Africa: A report from Wilms Africa—CANCaRe Africa

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