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Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa

Nature Reviews Clinical Oncology volume 10, pages 599–604 (2013)Cite this article

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Abstract

Over 80% of children with cancer live in low and middle-income countries where survival rates are much lower than high-income countries. Challenges to successful treatment of paediatric cancers in these countries include late presentation, malnutrition, failure to complete treatment and less-intense supportive care leading to increased treatment-related mortality and the need to reduce the intensity of treatment. Clinical trials can contribute to improved care and survival by providing objective information on the number of patients treated, accuracy of diagnosis, causes of treatment failure and the efficacy of specific interventions. Clinical trials can also help to build capacity (salary support and training), improve facilities (equipment) and fund treatment or essential associated costs (social support, nutritional support and follow-up care). In this article, we discuss our experience with clinical trials in Malawi and sub-Saharan Africa with emphasis on the treatment of children with Wilms tumour.

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Figure 1: Causes of treatment failures (deaths) in percentages in patients with Wilms tumour in Malawi (n = 73).24

References

  1. Graf, N., Tournade, F. & de Kraker, J. The role of preoperative chemotherapy in the management of Wilms' tumor. The SIOP studies. International Society of Pediatric Oncology. Urol. Clin. North Am. 27, 443–454 (2000).

    Article  CAS  Google Scholar 

  2. Kremer, L. C. et al. A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Pediatr. Blood Cancer 60, 543–549 (2013).

    Article  Google Scholar 

  3. Magrath, I. et al. Paediatric cancer in low-income and middle-income countries. Lancet Oncol. 14, e104–e116 (2013).

    Article  Google Scholar 

  4. Ribeiro, R. C. et al. Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study. Lancet Oncol. 9, 721–729 (2008).

    Article  Google Scholar 

  5. Ferlay, J. et al. GLOBOCAN 2008 v2.0—cancer incidence and mortality worldwide: IARC CancerBase No 10. Lyon: International Agency for Research on Cancer, 2010 [online], (2013).

    Google Scholar 

  6. Israels, T., Ribeiro, R. C. & Molyneux, E. M. Strategies to improve care for children with cancer in sub-Saharan Africa. Eur. J. Cancer 46, 1960–1966 (2010).

    Article  Google Scholar 

  7. UNICEF. The state of the world's children 2013: children with disabilities [online], (2013).

  8. Olweny, C. L. et al. Long-term experience with Burkitt's lymphoma in Uganda. Int. J. Cancer 26, 261–266 (1980).

    Article  CAS  Google Scholar 

  9. Ziegler, J. L., Morrow, R. H. Jr, Fass, L., Kyalwazi, S. K. & Carbone, P. P. Treatment of Burkitt's tumor with cyclophosphamide. Cancer 26, 474–484 (1970).

    Article  CAS  Google Scholar 

  10. Burkitt, D. Long-term remissions following one and two-dose chemotherapy for African lymphoma. Cancer 20, 756–759 (1967).

    Article  CAS  Google Scholar 

  11. Kellie, S. J. & Howard, S. C. Global child health priorities: what role for paediatric oncologists? Eur. J. Cancer 44, 2388–2396 (2008).

    Article  Google Scholar 

  12. Israëls, T. et al. Acute malnutrition is common in Malawian patients with a Wilms tumour: a role for peanut butter. Pediatr. Blood Cancer 53, 1221–1226 (2009).

    Article  Google Scholar 

  13. Molyneux, E. et al. Practical issues in relation to clinical trials in children in low-income countries: experience from the front line. Arch. Dis. Child. 97, 848–851 (2012).

    Article  Google Scholar 

  14. Israëls, T. et al. The guardians' perspective on paediatric cancer treatment in Malawi and factors affecting adherence. Pediatr. Blood Cancer 51, 639–642 (2008).

    Article  Google Scholar 

  15. Israëls, T. et al. Malnourished Malawian patients presenting with large Wilms tumours have a decreased vincristine clearance rate. Eur. J. Cancer 46, 1841–1847 (2010).

    Article  Google Scholar 

  16. WHO. WHO Model Lists of Essential Medicines [online] (2013).

  17. Sinfield, R. L. et al. Spectrum and presentation of pediatric malignancies in the HIV era: experience from Blantyre, Malawi, 1998–2003. Pediatr. Blood Cancer 48, 515–520 (2007).

    Article  CAS  Google Scholar 

  18. Hesseling, P. et al. The 2000 Burkitt lymphoma trial in Malawi. Pediatr. Blood Cancer 44, 245–250 (2005).

    Article  Google Scholar 

  19. Hesseling, P., Molyneux, E., Kamiza, S., Israels, T. & Broadhead, R. Endemic Burkitt lymphoma: a 28-day treatment schedule with cyclophosphamide and intrathecal methotrexate. Ann. Trop. Paediatr. 29, 29–34 (2009).

    Article  CAS  Google Scholar 

  20. Hesseling, P. B. et al. Malawi pilot study of Burkitt lymphoma treatment. Med. Pediatr. Oncol. 41, 532–540 (2003).

    Article  Google Scholar 

  21. Hesseling, P. B., Molyneux, E., Kamiza, S. & Broadhead, R. Rescue chemotherapy for patients with resistant or relapsed endemic Burkitt's lymphoma. Trans. R. Soc. Trop. Med. Hyg. 102, 602–607 (2008).

    Article  CAS  Google Scholar 

  22. Hesseling, P. B. et al. The Cameroon 2008 Burkitt lymphoma protocol: improved event-free survival with treatment adapted to disease stage and the response to induction therapy. Pediatr. Hematol. Oncol. 29, 119–129 (2012).

    Article  CAS  Google Scholar 

  23. Israëls, T. et al. Preoperative chemotherapy for patients w-ith Wilms tumor in Malawi is feasible and efficacious. Pediatr. Blood Cancer 53, 584–589 (2009).

    Article  Google Scholar 

  24. Israëls, T. et al. Management of children with a Wilms tumor in Malawi, sub-Saharan Africa. J. Pediatr. Hematol. Oncol. 34, 606–610 (2012).

    Article  Google Scholar 

  25. Wilde, J. C. et al. Challenges and outcome of Wilms' tumour management in a resource-constrained setting. Afr. J. Paediatr. Surg. 7, 159–162 (2010).

    Article  CAS  Google Scholar 

  26. Israëls, T. et al. Nutritional status at admission of children with cancer in Malawi. Pediatr. Blood Cancer 51, 626–628 (2008).

    Article  Google Scholar 

  27. Orem, J. et al. Capacity building for the clinical investigation of AIDS malignancy in East Africa. Cancer Detect. Prev. 29, 133–145 (2005).

    Article  Google Scholar 

  28. Harif, M. et al. Treatment of childhood cancer in Africa. Preliminary results of the French-African paediatric oncology group [French]. Arch. Pediatr. 12, 851–853 (2005).

    Article  CAS  Google Scholar 

  29. Hesseling, P. B. et al. Treating Burkitt's lymphoma in Malawi, Cameroon, and Ghana. Lancet Oncol. 9, 512–513 (2008).

    Article  Google Scholar 

  30. Lavy, V. Presenting symptoms and signs in children referred for palliative care in Malawi. Palliat. Med. 21, 333–339 (2007).

    Article  Google Scholar 

  31. Molyneux, E. Post-conference thoughts from Malawi. Lancet 362, 2117 (2003).

    Article  Google Scholar 

  32. Israels, T. et al. SIOP PODC: clinical guidelines for the management of children with Wilms tumour in a low income setting. Pediatr. Blood Cancer 60, 5–11 (2013).

    Article  Google Scholar 

  33. WHO (Eds). Global Status Report on Noncommunicable Diseases 2010 (WHO, 2011).

  34. Chindo, L. Mobile phone use in Cameroon: an increasingly useful tool for the follow-up of children with Burkitt lymphoma. Pediatr. Blood Cancer 60, 524 (2013).

    Article  Google Scholar 

  35. Quintana, Y. et al. POND4Kids: a global web-based database for pediatric hematology and oncology outcome evaluation and collaboration. Stud. Health Technol. Inform. 183, 251–256 (2013).

    PubMed  Google Scholar 

  36. Davidoff, A. M. Wilms' tumor. Curr. Opin. Pediatr. 21, 357–364 (2009).

    Article  Google Scholar 

  37. Green, D. M. The treatment of stages I–IV favorable histology Wilms' tumor. J. Clin. Oncol. 22, 1366–1372 (2004).

    Article  Google Scholar 

  38. Abuidris, D. O. et al. Wilms tumour in Sudan. Pediatr. Blood Cancer 50, 1135–1137 (2008).

    Article  Google Scholar 

  39. Madani, A. et al. Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco. Pediatr. Blood Cancer 46, 472–475 (2006).

    Article  Google Scholar 

  40. Moreira, C. et al. Treatment of nephroblastoma in Africa: results of the first French African pediatric oncology group (GFAOP) study. Pediatr. Blood Cancer 58, 37–42 (2012).

    Article  Google Scholar 

  41. Mostert, S. et al. Abandonment of treatment for childhood cancer: position statement of a SIOP PODC Working Group. Lancet Oncol. 12, 719–720 (2011).

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Oncology, VU University Medical Centre, De Boelelaan 1117, Amsterdam, 1018HV, Netherlands

    Trijn Israëls & Gertjan J. L. Kaspers

  2. Department of Paediatrics, National Cancer Institute, Upper Mulago Hill Road, Kampala, Uganda

    Joyce Kambugu

  3. Mbingo Baptist Hospital, PMB 42, Bamenda, North West Region, Cameroon

    Francine Kouya

  4. Department of Paediatrics, Kamuzu Central Hospital, PO Box 149, Lilongwe, 265, Malawi

    Nader Kim El-Mallawany

  5. Department of Paediatrics and Child Health, Tygerberg Children's Hospital, University of Stellenbosch, PO Box 19063, Tygerberg, 7505, South Africa

    Peter B. Hesseling

  6. World Child Cancer, 17 Rudolf Place, London, SW8 1RP, UK

    Tim Eden

  7. Department of Child Health, University of Ghana Medical School, Guggisberg Avenue, Korle Bu, Accra, Ghana

    Lorna Renner

  8. Department of Paediatrics, College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi

    Elizabeth M. Molyneux

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  1. Trijn Israëls
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  4. Nader Kim El-Mallawany
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  5. Peter B. Hesseling
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Contributions

T. Israëls researched the data for the article and, with E. M. Molyneux, discussed the content of the manuscript. T. Israëls, J. Kambugu, F. Kouya, N. K. El-Mallawany, L. Renner and E. M. Molyneux wrote the article, and T. Israëls, P. B. Hesseling, G. J. L. Kaspers, T. Eden and E. M. Molyneux edited and revised the manuscript prior to submission.

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Correspondence to Trijn Israëls.

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The authors declare no competing financial interests.

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Israëls, T., Kambugu, J., Kouya, F. et al. Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa. Nat Rev Clin Oncol 10, 599–604 (2013). https://doi.org/10.1038/nrclinonc.2013.137

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