Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes

Schroeder, Kristin; Saxton, Anthony T.; McDade, Jessica E.; Chao, Christina A.; Masalu, Nestory; Chao, Colin; Wechsler, Daniel S.; Likonda, Beda; Chao, Nelson J.

doi:10.1200/jgo.2016.009027

Cited by 30 publications

(43 citation statements)

References 22 publications

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“…24,28,36 This is in contrast to previous studies from other African countries that reported lymphomas as the most common tumours affecting the paediatric population. 11,22,34 We found that the majority of children with lymphomas were older than 5 years, which is similar to the findings of a recent report from Yemen. 29 In HICs, CNS tumours are the second most diagnosed cancers and represent 20% to 27% of all paediatric cancers.…”

Section: Discussionsupporting

confidence: 81%

“…10,28,32,33 This is in contrast to many LMICs, where leukaemias are much less frequent than lymphomas. 8,21,22,34 We found that most children with leukaemias were boys, which is also similar to that reported in other studies. 23,35 Most of the children in our analysis resided in rural regions of Sudan, where tertiary medical care is lacking.…”

Section: Discussionsupporting

confidence: 81%

“…39,40 This is similar to our findings but low when compared with the frequency of retinoblastoma reported in some LMICs. 34,41 The data from Africa suggest that, in many of the populations of sub-Saharan Africa, rates are rather higher than in HICs. 11 We found that most retinoblastomas occurred in children younger than 5 years, which is similar to findings reported in other studies.…”

Section: Gender Percentage (%)mentioning

confidence: 99%

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Epidemiological review of childhood cancers in central Sudan

et al. 2018

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Background: Epidemiological studies of paediatric cancer incidence in Sudan are rare.Objectives: The aim of this study was to provide baseline information about the epidemiology of childhood cancers in patients treated at the National Cancer Institute (NCI) in Wad Medani, Sudan.Methods: We performed a retrospective health facility–based study of cancer incidence and patient characteristics of children who were treated at the NCI from January 1999 to December 2015. The changing patterns of cancers incidence during the study period were also recorded.Results: Of 15 387 new patients with cancer who were registered at the NCI during the study period, 1159 (7.5%) were children (younger than 15 years). The mean age of the paediatric patients was 7 years, with standard deviation of 5. Most of the patients (36%) were 10 to 15 years old, 33% were 0 to 4 years old and 31% were 5 to 10 years old. Among the study population, 60% were males and 40% were females. Approximately 76% of children lived in rural areas in Sudan. Leukaemias (29%) and lymphomas (26%) comprised 55% of all paediatric cancers. Central nervous system (CNS) tumours constituted 6% of all paediatric tumours, whereas non-CNS embryonal tumours (i.e. nephroblastoma, neuroblastoma, hepatoblastoma and retinoblastoma) accounted for 20%. The average number of cases per year increased from 42 in 1999–2005 to 75 in 2006–2010 and 106 in 2011–2015.Conclusion: The number of patients seeking treatment for childhood cancers has increased every year in central Sudan. Leukaemias and lymphomas constitute more than half of these cancers. A population-based cancer registry is needed to determine the true incidence of childhood cancers in Sudan.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 81%

Section: Gender Percentage (%)mentioning

confidence: 99%

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Epidemiological review of childhood cancers in central Sudan

et al. 2018

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“…In Mwanza, Tanzania, Bugando Medical Centre (BMC) serves as the area's Zonal consultant hospital, with a catchment area of the entire lake region [3] serving over 15 million people [4]. In the past ten years, BMC has worked to create, staff and train advanced oncology, surgery, and pathology departments to provide cancer diagnostic, treatment, and radiation services [2].…”

Section: Introductionmentioning

confidence: 99%

Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

et al. 2020

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Background: Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. Methods: A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. Results: Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. Conclusions: The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.

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“…Historically, 2-year survival rates at BMC were 20%, with 52% of cancer diagnoses considered palliative at presentation, because of late presentation and limited diagnostic and therapeutic resources (K. Schroeder, personal communication, June 15, 2016). 13 No national health insurance plan exists in Tanzania, and 67.9% of the population lives below the poverty line. 14 , 15 With the average cost of a cancer diagnosis and treatment at $560 per patient, 16 most caregivers cannot afford life-saving interventions for patients, resulting in a large number of terminally ill children in Tanzania.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

Esmaili

Stewart

Masalu

et al. 2018

JGO

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PurposePalliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context.MethodsIn-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients.ResultsData from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background.ConclusionThis study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective—and more appropriate—palliative care policies for young patients with cancer in the developing world.

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Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes

Cited by 30 publications

References 22 publications

Epidemiological review of childhood cancers in central Sudan

Epidemiological review of childhood cancers in central Sudan

Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

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