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

被引:6
作者
Atwiine, Barnabas [1 ]
Mdoka, Cecilia [2 ]
Branchard, Mushabe [1 ]
Chagaluka, George [3 ]
Fufa, Diriba [4 ]
Ayalew, Mulugeta [5 ]
Khofi, Harriet [2 ,3 ]
Amankwah, Emmanuel [6 ]
Chokwenda, Nester [7 ]
Birhane, Feven [5 ]
Mezgebu, Esubalew [4 ]
Eklu, Bernice [8 ]
Jator, Brian [9 ]
Kudowa, Evaristar [10 ]
Mbah, Glenn [9 ]
Wassie, Mulugeta [5 ]
Dondo, Vongai [7 ]
Paintsil, Vivian [8 ]
Pritchard-Jones, Kathy [11 ]
Renner, Lorna Awo [6 ]
Sung, Lillian [12 ]
Kouya, Francine [9 ]
Molyneux, Elizabeth [3 ]
Chitsike, Inam [7 ]
Israels, Trijn [2 ,3 ,13 ]
机构
[1] Mbarara Univ Sci & Technol, Mbarara, Uganda
[2] CANCaRe Africa, Collaborat African Network Childhood Canc Care & R, Blantyre, Malawi
[3] Kamuzu Univ Hlth Sci KUHES, Paediat & Child Hlth, Blantyre, Malawi
[4] Jimma Univ, Pediat & Child Hlth, Jimma, Ethiopia
[5] Univ Gondar Specialized Hosp, Unit Pediat Hematol Oncol, Gondar, Ethiopia
[6] Korle Bu Teaching Hosp Accra, Child Hlth, Accra, Ghana
[7] Coll Hlth Sci, Pediat, Harare, Zimbabwe
[8] Komfo Anokye Teaching Hosp, Paediat Oncol, Kumasi, Ghana
[9] Mbingo Baptist Hosp, Paediat, Mbingo, Cameroon
[10] Malawi Liverpool Wellcome Res Programme, Dept Stat, Blantyre, Malawi
[11] UCL, Global Hlth, London, England
[12] Sick Childrens Hosp, Toronto, ON, Canada
[13] Kamuzu Univ Hlth Sci KUHeS, Dept Paediat, Wilms Africa CANCaRe Africa, Blantyre, Malawi
关键词
Africa; nephroblastoma; resource-limited settings; survival; treatment abandonment; Wilms tumor; LOW-INCOME; CHILDREN; CANCER; WORKING;
D O I
10.1002/pbc.31069
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The 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. Methods: Wilms 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. Results: We 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. Conclusion: Provision 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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页数:6
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