Childhood cancer survival rates in two South African units

Abstract

Introduction. Childhood cancer is relatively rare, but there is a very good chance of cure. While overall survival rates of >70% are reported from developed countries, survival is much less likely in developing countries and unknown in many countries in Africa. Objective. To analyse survival rates of childhood cancers in two South African paediatric oncology units. Methods. This retrospective review included all children (0 -15 years) admitted with a malignancy at two paediatric oncology units (Universitas Hospital Academic Complex in Bloemfontein, Free State, and Tygerberg Hospital in Cape Town, Western Cape) between 1987 and 2011. The protocols used in the units were similar, and all the diagnoses were confirmed histologically.Results. There were 3 241 children, 53.5% of whom were males. Median follow-up was 17 months. The most common cancers were leukaemia (25.0%), brain tumours (19.5%), lymphoma (13.0%) and nephroblastoma (10.0%). The prevalences of neuroblastoma and retinoblastoma were similar at 5.8% and 5.7%, respectively. Overall survival was calculated to be 52.1%. Lymphoma and nephroblastoma had the highest survival rates at 63.9% and 62.6%, respectively. Brain tumours had the lowest survival rate at 46.4%. A comparison between ethnic groups showed white children to have the highest survival rate (62.8%); the rate for children of mixed racial origin was 53.8% and that for black children 48.5%. Conclusions. Overall survival rates for children admitted to two paediatric cancer units in South Africa were lower than data published from developed countries, because many children presented with advanced disease. New strategies to improve cancer awareness are urgently required.

Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

“…Ballot et al described an imbalance between the numbers of paediatric patients requiring PICU and the availability of PICU facilities in Johannesburg, concluding that patients should be carefully selected to utilise these scarce resources to the best advantage. 20 The 4-year OS rate of paediatric oncology patients who survive a PICU admission in this study, while low, is no worse than the published 4-year OS for all oncology patients in South Africa 9 and suggests that these patients should not be denied admission to PICU based on their underlying diagnosis. It is imperative that oncologists select PICU candidates with a good projected chance of survival and continue to communicate closely with intensivists.…”

“…9,10,11 Today, children diagnosed with cancer have a projected survival rate of approximately 80% in high-income countries 11,12 in comparison with the published OS rate of 52.1% in middleincome South Africa. 9 The number of oncology patients requiring admission to the PICU has increased, reaching up to 40% 12 of patients during the course of their disease in both low-and high-income centres. 6,11,13,14 These children often have severe myelo-and immunosuppression and are more likely than other paediatric patients to require PICU care.…”

Childhood cancer incidence patterns by race, sex and age for 2000–2006: A report from the South African National Cancer Registry

“…Under‐diagnosis, due to clinicians being less experienced at recognizing leukemias in children may partly explain this finding. Findings from the Tygerberg and Bloemfontein hospitals highlight the need to increase parental awareness of childhood cancer on the one hand but also to increase the sensitivity of medical doctors and health professionals to the warning signs of childhood cancers . Many Sub‐Saharan African countries report few brain tumors and substantial underestimation is assumed .…”

“…Survival for many childhood cancers, when diagnosed at an early stage, is generally very good, with recent survival probabilities for children with cancer exceeding 80% in several European countries . In contrast, survival from childhood cancer is much lower in South Africa, with reported survival rates of less than 50% among African Blacks . This underlines the importance of raising awareness, training healthcare providers, enhancing diagnostic capacities, and facilitating access to medical services for poor families, as most pediatric cancers are potentially curable …”

Relationship between nutritional status and treatment-related neutropenia in children with nephroblastoma

“…1,3 However, 80% of children with nephroblastoma live in poor countries and present at an advanced stage of disease, with malnutrition and associated co-morbidities, and face much lower survival rates. 4 Adequate and appropriate nutrition in paediatric oncology patients is essential for maintaining growth and development. It may also improve survival, decrease treatment-related toxicity, and improve quality of life.…”