Presentation and Outcomes of Childhood Cancer Patients at Uganda Cancer Institute

Introduction. Limited data suggest that children with cancer in sub-Saharan Africa have poor survival. We aimed to describe the presentation, treatment outcomes, and factors associated with survival among children with cancer managed at Uganda Cancer Institute. Methods. We retrospectively evaluated patients with childhood cancer (age ≤19 years) from Kyadondo County treated at Uganda Cancer Institute from 2006 to 2009. Cox’s regression and Kaplan-Meier methods were used to study 1-year survival. Results. Among 310 patients studied, median age was 7 years (range = 0.25-19 years), 64% were boys, and 92% had histological confirmation of cancer diagnosis. The commonest diagnoses were Burkitt lymphoma (BL, N = 87), Kaposi sarcoma (KS, N = 68), non-BL non-Hodgkin lymphoma (NHL, N = 32), acute lymphoblastic leukemia (ALL, N = 28), Wilms (N = 28), and Hodgkin disease (HD, N = 20). Advanced disease at diagnosis was common for all cancers (ranging from 45% for KS to 83% for non-BL NHL). Overall, 33.2% abandoned treatment. One-year survival was 68% for HD (95% confidence interval [CI] = 11.3-40.6), 67% for KS (95% CI = 52.1-77.9), 55% for BL (95% CI = 42-66.9), 44% for Wilms (95% CI = 22.5-63), 43% for non-BL NHL (95% CI = 23.3-61.3), and 20% for ALL (95% CI = 6.4-38.7). In univariate and multivariate analysis, anemia and thrombocytopenia were associated with mortality for several cancers. Conclusion. Survival among children with cancer in Uganda is poor. Advanced stage disease and loss to follow-up likely contribute to poor outcomes. Anemia and thrombocytopenia may augment traditional staging methods to provide better prognostic factors in Uganda and warrant further evaluation.

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Distance-Based Education for Nurses Caring for Children With Cancer in Sub-Saharan Africa

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454220938355 ◽

2020 ◽

Vol 37 (5) ◽

pp. 321-329

Author(s):

Marilyn Hockenberry ◽

Tadala Mulemba ◽

Aisha Nedege ◽

Kitsiso Madumetse ◽

Jennifer Higgins

Keyword(s):

Nursing Education ◽

Childhood Cancer ◽

Pediatric Oncology ◽

Core Competencies ◽

Course Evaluation ◽

Sub Saharan Africa ◽

Oncology Nursing ◽

Full Time ◽

Children With Cancer ◽

Sub Saharan

Nursing specialization in the care of children with cancer provides the foundation for implementing successful childhood cancer and blood disorder treatment programs throughout the world. Excellence in nursing education is at the center of all that is needed to maximize cures for children with cancer in low- and middle-income countries (LMIC). While the burden of childhood cancer care is the highest in LMIC, opportunities for continuing nursing education and specialization are extremely limited. Capacity-building programs using distance-based learning opportunities have been successful in sub-Saharan Africa and provide insight into successful, continuing professional development. The Global Hematology-Oncology Pediatric Excellence (HOPE) program part of Texas Children’s Hospital in Houston, Texas, has developed and implemented a distance-based training program designed for nurses working in sub-Saharan Africa. Following a needs assessment, Global HOPE developed a program using both the Moodle (modular object-oriented dynamic learning environment) distance-based learning platform and computer notebooks that hold the course content. The program teaches basic principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana. Courses are taught using a modular approach and core competencies are established for each module. Frequent teaching sessions using Zoom and WhatsApp reinforce independent learning experiences. Formal course evaluation includes written pre- and posttests, self-competency assessments, and simulated checkoffs on essential pediatric oncology nursing competencies. The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMIC to become full-time specialists in pediatric oncology nursing.

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Clinical Trials for Treatment and Prevention of HIV-Associated Malignancies in Sub-Saharan Africa: Building Capacity and Overcoming Barriers

JCO Global Oncology ◽

10.1200/go.20.00153 ◽

2020 ◽

pp. 1134-1146 ◽

Cited By ~ 1

Author(s):

Lilie L. Lin ◽

David S. Lakomy ◽

Elizabeth Y. Chiao ◽

Robert M. Strother ◽

Meg Wirth ◽

...

Keyword(s):

Clinical Trials ◽

Cervical Dysplasia ◽

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Current Status ◽

People Living With Hiv ◽

Non Hodgkin Lymphoma ◽

Treatment And Prevention ◽

Sub Saharan ◽

Living With Hiv

PURPOSE The aim of this study was to review the current status of clinical trials for HIV-associated malignancies in people living with HIV in sub-Saharan Africa (SSA) and efforts made by the AIDS Malignancy Consortium (AMC) to build capacity in SSA for HIV malignancy research. METHODS All malignancy-related clinical trials in 49 SSA countries on ClinicalTrials.gov were reviewed and evaluated for inclusion and exclusion criteria pertaining to HIV status. Additional studies by AMC in SSA were compiled from Web-based resources, and narrative summaries were prepared to highlight AMC capacity building and training initiatives. RESULTS Of 96 cancer trials identified in SSA, only 11 focused specifically on people living with HIV, including studies in Kaposi sarcoma, cervical dysplasia and cancer, non-Hodgkin lymphoma, and ocular surface squamous neoplasia. Recognizing the increasing cancer burden in the region, AMC expanded its clinical trial activities to SSA in 2010, with 4 trials completed to date and 6 others in progress or development, and has made ongoing investments in developing research infrastructure in the region. CONCLUSION As the HIV-associated malignancy burden in SSA evolves, research into this domain has been limited. AMC, the only global HIV malignancy-focused research consortium, not only conducts vital HIV-associated malignancies research in SSA, but also develops pathology, personnel, and community-based infrastructure to meet these challenges in SSA. Nonetheless, there is an ongoing need to build on these efforts to improve HIV-associated malignancies outcomes in SSA.

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Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Blood ◽

10.1182/blood-2012-02-387092 ◽

2012 ◽

Vol 119 (22) ◽

pp. 5078-5087 ◽

Cited By ~ 49

Author(s):

Satish Gopal ◽

William A. Wood ◽

Stephanie J. Lee ◽

Thomas C. Shea ◽

Kikkeri N. Naresh ◽

...

Keyword(s):

Infectious Diseases ◽

Hodgkin Lymphoma ◽

Kaposi Sarcoma ◽

Hematologic Malignancies ◽

Sub Saharan Africa ◽

Hematopoietic Stem ◽

Barr Virus ◽

Non Hodgkin Lymphoma ◽

Sub Saharan ◽

The Impact

Cancer is a leading cause of death and disability in sub-Saharan Africa and will eclipse infectious diseases within the next several decades if current trends continue. Hematologic malignancies, including non-Hodgkin lymphoma, leukemia, Hodgkin lymphoma, and multiple myeloma, account for nearly 10% of the overall cancer burden in the region, and the incidence of non-Hodgkin lymphoma and Hodgkin lymphoma is rapidly increasing as a result of HIV. Despite an increasing burden, mechanisms for diagnosing, treating, and palliating malignant hematologic disorders are inadequate. In this review, we describe the scope of the problem, including the impact of endemic infections, such as HIV, Epstein-Barr virus, malaria, and Kaposi sarcoma–associated herpesvirus. We additionally describe current limitations in hematopathology, chemotherapy, radiotherapy, hematopoietic stem cell transplantation, and supportive care and palliation. We review contemporary treatment and outcomes of hematologic malignancies in the region and outline a clinical service and research agenda, which builds on recent global health successes combating HIV and other infectious diseases. Achieving similar progress against hematologic cancers in sub-Saharan Africa will require the sustained collaboration and advocacy of the entire global cancer community.

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Mapping the Epidemiology of Kaposi Sarcoma and Non-Hodgkin Lymphoma Among Children in Sub-Saharan Africa: A Review

Pediatric Blood & Cancer ◽

10.1002/pbc.26021 ◽

2016 ◽

Vol 63 (8) ◽

pp. 1325-1331 ◽

Cited By ~ 12

Author(s):

Chris A. Rees ◽

Elizabeth M. Keating ◽

Heather Lukolyo ◽

Heather E. Danysh ◽

Michael E. Scheurer ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Non Hodgkin Lymphoma ◽

Sub Saharan

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Faculty Opinions recommendation of Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726698717.793523215 ◽

2016 ◽

Author(s):

Simon Portsmouth

Keyword(s):

Antiretroviral Therapy ◽

Children And Adolescents ◽

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Combination Antiretroviral Therapy ◽

Sub Saharan

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Modified EPOCH for high‐risk non‐Hodgkin lymphoma in sub‐Saharan Africa

Cancer Medicine ◽

10.1002/cam4.2631 ◽

2019 ◽

Vol 9 (1) ◽

pp. 77-83 ◽

Cited By ~ 2

Author(s):

Takondwa Zuze ◽

Grace K. Ellis ◽

Edwards Kasonkanji ◽

Bongani Kaimila ◽

Richard Nyasosela ◽

...

Keyword(s):

High Risk ◽

Hodgkin Lymphoma ◽

Sub Saharan Africa ◽

Non Hodgkin Lymphoma ◽

Sub Saharan

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Transmission of Kaposi sarcoma-associated herpesvirus in sub-Saharan Africa

AIDS ◽

10.1097/qad.0b013e3282f4352e ◽

2008 ◽

Vol 22 (4) ◽

pp. 535-537 ◽

Cited By ~ 6

Author(s):

Sam M Mbulaiteye ◽

James J Goedert

Keyword(s):

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Sub Saharan

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Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

Pediatric Health Medicine and Therapeutics ◽

10.2147/phmt.s142816 ◽

2018 ◽

Vol Volume 9 ◽

pp. 35-46 ◽

Cited By ~ 11

Author(s):

Nader Kim El-Mallawany ◽

Casey L McAtee ◽

Liane R Campbell ◽

Peter N Kazembe

Keyword(s):

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Hiv Epidemic ◽

Sub Saharan

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How Well Do All Patient Refined–Diagnosis-Related Groups Explain Costs of Pediatric Cancer Chemotherapy Admissions in the United States?

Journal of Oncology Practice ◽

10.1200/jop.2015.010330 ◽

2016 ◽

Vol 12 (5) ◽

pp. e564-e575 ◽

Cited By ~ 5

Author(s):

Heidi Russell ◽

Andrew Street ◽

Vivian Ho

Keyword(s):

Childhood Cancer ◽

Hodgkin Lymphoma ◽

Cancer Chemotherapy ◽

Diagnosis Related Groups ◽

Lymphoblastic Leukemia ◽

Hospital Costs ◽

The United States ◽

Non Hodgkin Lymphoma ◽

Acute Myelomonocytic Leukemia ◽

Management Changes

Purpose: State-based Medicaid programs have begun using All Patient Refined–Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy changes. Methods: We identified 25,613 chemotherapy admissions in the 2009 Kids’ Inpatient Database. To determine how well APR-DRGs explain costs, we applied a hierarchic linear regression model of hospital costs, allowing for a variety of patient, hospital, and geographic confounders. Results: APR-DRGs proved to be the most important predictors of admission costs (P < .001), with costs increasing by DRG severity code. Diagnosis, age, and hospital characteristics also predicted costs above and beyond those explained by APR-DRGs. Compared with admissions for patients with acute lymphoblastic leukemia, costs of admissions for patients with acute myelomonocytic leukemia were 82% higher; non-Hodgkin lymphoma, 20% higher; Hodgkin lymphoma, 25% lower; and CNS tumors, 27% lower. Admissions for children who were 10 years of age or older cost 26% to 35% more than admissions for infants. Admissions to children’s hospitals cost 46% more than admissions to other hospital types. Conclusion: APR-DRGs developed for adults are applicable to childhood cancer chemotherapy but should be refined to account for cancer diagnosis and patient age. Possible policy and clinical management changes merit further study to address factors not captured by APR-DRGs.

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