Implementing the WHO Global Initiative for Childhood Cancer in Morocco: Survival study for the six indexed childhood cancers

Mechita, Nada Bennani; Cherkaoui, Siham; Abousselham, Loubna; Benmiloud, Sarra; Kili, Amina; Kababri, Maria El; Maani, K.; Houdzi, Jamila El; Benajiba, Noufissa; Madani, Abdellah; Bennani, Maria; Belakhel, Latefa; Bouffet, Éric; Patte, Catherine; Harif, Mhamed; Youbi, Mohammed; Hessissen, Laïla

doi:10.1002/pbc.29788

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…12,13 Despite great progress in high-income countries (HICs), reported survival rates in LMICs are less than 50%. 12,14 Delayed presentation with advanced localized and/or metastatic disease, malnutrition, incomplete staging workup, suboptimal surgical and histopathological expertise, malnutrition, inadequate supportive care facilities, treatment abandonment, and scarcity of collaborative research has been identified as critical barriers to achieving better survival outcomes in LMICs. [15][16][17] This study illustrates the disparities in pre-referral management and its impact on survival outcomes, in comparison to the patients who were treated with F I G U R E 3 Continued pre-operative chemotherapy followed by nephrectomy performed at a large pediatric oncology unit in an LMIC.…”

Section: Discussionmentioning

confidence: 99%

“…WT is one of the most curable cancers in childhood and is identified as one of the six common and curable cancers within the WHO Global Initiative for childhood cancer 12,13 . Despite great progress in high‐income countries (HICs), reported survival rates in LMICs are less than 50% 12,14 . Delayed presentation with advanced localized and/or metastatic disease, malnutrition, incomplete staging workup, suboptimal surgical and histopathological expertise, malnutrition, inadequate supportive care facilities, treatment abandonment, and scarcity of collaborative research has been identified as critical barriers to achieving better survival outcomes in LMICs 15–17 .…”

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of pre‐referral tumor resection in unilateral Wilms tumor: A single‐institute experience from a lower middle‐income country

Khan,

Maaz,

Qazi

et al. 2023

Pediatric Blood & Cancer

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IntroductionThe objectives of this study were to evaluate the prognostic impact of pre‐referral surgical resection of Wilms tumor (WT) performed at non‐oncology centers, and to strategize an improved care plan for this very curable pediatric tumor.MethodsIn this study conducted in a large pediatric cancer center in Pakistan, we retrospectively reviewed the electronic medical records (EMR) of 149 patients with unilateral WT from September 2008 to August 2017. Based on treatment approach, patients were categorized into two groups: (i) pre‐referral tumor resection (PTR: n = 75), and (ii) post‐neoadjuvant chemo nephrectomy (PCN: n = 74).ResultsThe proportion of metastatic disease in PTR and PCN groups was 33.3% and 35.1%, respectively. In the PTR subset, median time to admission after PTR was 5 weeks (mean 11, SEM 2.8, range: 2–202) weeks, with 53.3% (n = 40) presenting more than 4 weeks after PTR. Twenty patients had no cross‐sectional imaging prior to PTR and underwent surgery after abdominal ultrasound only. On baseline imaging at our center, 58.7% (n = 44) of the PTR group had radiologically evaluable disease (four metastases only, 19 local residual tumor only, 21 both localized tumor and visible metastases). Disease staging was uncertain in 23 patients because of no or inadequate histology specimens and/or lymph node sampling in patients with no evaluable disease. Statistically significant differences were recorded for the two subsets regarding tumor volume, extent and nodularity, renal vein and renal sinus involvement, lymph node status, tumor rupture and histopathologic features, and tumor stage, with a 10‐year event‐free survival (EFS) for PCN and PTR of 74.3% and 50.7%, respectively (p < .001). In the PTR group, EFS for those presenting within 4 weeks and later was 91.4% versus 15.0%, respectively (p < .0001).ConclusionSuboptimal pre‐referral surgical intervention results in poor survival outcomes in unilateral WT. Our findings highlight the need for a comprehensive action plan for educating healthcare professionals engaged in WT diagnosis and referral process. PCN in a multidisciplinary team approach can reduce surgical morbidity and seems to be a better strategy to improve the survival rates in low‐resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic impact of pre‐referral tumor resection in unilateral Wilms tumor: A single‐institute experience from a lower middle‐income country

Khan,

Maaz,

Qazi

et al. 2023

Pediatric Blood & Cancer

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“…Survival outcomes in low‐ and middle‐income countries (L/MICs) where approximately 90% of children with cancer are diagnosed are much less optimistic, mainly because of poor healthcare resources and infrastructure 1,2 . However, international collaboration has been helping to reduce the survival gap over the past years, and strong alliances and partnerships by international pediatric oncology stakeholders including the International Society of Pediatric Oncology (SIOP) and World Health Organization offer a hopeful future for childhood cancer outcomes in disadvantaged regions of the world 3,4 …”

Section: Introductionmentioning

confidence: 99%

“…1,2 However, international collaboration has been helping to reduce the survival gap over the past years, and strong alliances and partnerships by international pediatric oncology stakeholders including the International Society of Pediatric Oncology (SIOP) and World Health Organization offer a hopeful future for childhood cancer outcomes in disadvantaged regions of the world. 3,4 Despite improvements in cure rates, it is understandably a devastating event for a family when a child is diagnosed with cancer. In addition to the physically grueling aspects of the disease, there are numerous psychosocial challenges that often accompany diagnosis, treatment, hospitalizations, and long-term survival or end-of-life.…”

mentioning

confidence: 99%

Psychosocial services for pediatric oncology patients in low‐ and middle‐income countries from health care providers' perspectives: A survey‐based report from the SIOP Global Health Network Psychosocial Working Group

Schneider,

Rossell,

Khan

2023

Psycho-Oncology

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ObjectivesWhile pediatric cancer survival rates have improved in high‐income countries, they remain much lower in low‐ and middle‐income countries (L/MICs). While much focus in recent years has been on remediating the survivorship gap, less is known about the psychosocial needs and availability of psychosocial services for this population.MethodsA questionnaire was created by the SIOP Global Health Network Psychosocial Working Group to assess psychosocial needs and services in L/MIC. The questionnaire was distributed to pediatric oncology professionals, both in‐person at the SIOP Annual Congress in Lyon (2019) conference and then electronically. Individuals not part of SIOP were also invited to participate via social media posts.ResultsSixty‐six respondents from 31 countries completed the questionnaire. The majority of participants were physicians, followed by nurses. Participants from low‐ and lower‐middle‐income countries (L/LMICs) perceived patients as having higher rates of anxiety and caregivers as having higher rates of depression as compared to those in upper‐middle‐income countries (UMICs). Across all L/MICs represented, 85% of physicians reported that psychosocial issues sometimes, frequently, or always affect their clinical obligations. Participants reflected on the availability of professionals who treat mental health concerns; the availability of social workers, psychologists, and non‐professional volunteers differed significantly between L/LMICs and UMICs. Treatment abandonment and myths/disinformation were highlighted as the most pressing psychosocial priorities.ConclusionOur study highlights pediatric oncology providers' perceptions of psychosocial concerns. Based on responses, proposals for minimum standards of care are made, as well as the importance of training existing providers and funding additional psychosocially‐focused professionals.

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“…Retrospective reports have documented relatively high survival rates for paediatric Hodgkin lymphoma (HL) with 85% 3‐year overall survival (OS) in Morocco 1 and 96% 5‐year OS in Egypt, 2 both lower middle‐income countries. There are minimal prospective data on HL survival in Africa, and hardly any data on children with human immunodeficiency virus (HIV).…”

Section: Introductionmentioning

confidence: 99%

Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Geel,

van Zyl,

Plessis

et al. 2023

Pediatric Blood & Cancer

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BackgroundHistoric South African 5‐year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)‐positive and HIV‐negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response‐adapted therapy could increase the OS of childhood and adolescent HL.MethodsSeventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk‐stratified, response‐adapted treatment protocol from July 2016 to December 2022. Low‐ and intermediate‐risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High‐risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV‐positive patients could receive granulocyte colony‐stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan–Meier survival analysis was performed to determine 2‐year OS and Cox regression to elucidate prognostic factors.ResultsThe cohort comprised 132 patients (19 HIV‐positive, 113 HIV‐negative), median age of 9.7 years, with a median follow‐up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two‐year OS was 100% for low‐risk, 93% for intermediate‐risk, and 91% for high‐risk patients. OS for HIV‐negative (93%) and HIV‐positive (89%) patients were similar (p = .53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p = .02).ConclusionIn the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two‐year OS of HIV‐positive and HIV‐negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.

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Implementing the WHO Global Initiative for Childhood Cancer in Morocco: Survival study for the six indexed childhood cancers

Cited by 11 publications

References 14 publications

Prognostic impact of pre‐referral tumor resection in unilateral Wilms tumor: A single‐institute experience from a lower middle‐income country

Prognostic impact of pre‐referral tumor resection in unilateral Wilms tumor: A single‐institute experience from a lower middle‐income country

Psychosocial services for pediatric oncology patients in low‐ and middle‐income countries from health care providers' perspectives: A survey‐based report from the SIOP Global Health Network Psychosocial Working Group

Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

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