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

来源：

PEDIATRIC BLOOD & CANCER | 2024年 / 71卷 / 08期

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.

引用

页数：6