Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Carter, Nicholas H.; Avery, Andrew H.; Libes, Jaime; Lovvorn, Harold N.; Hansen, Erik N.

doi:10.3390/children5110143

Cited by 12 publications

(16 citation statements)

References 45 publications

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“…The focus of research for LMICs should be on creating greater awareness in the diagnosis of NB, improving diagnostics and establishing social support strategies for successful, harmonised management protocols and homogenous treatment facilities to improve outcomes[ 55 , 75 ]. The main priority should be accurate tumour registries to document not only the most common or treatable childhood malignancies but also the rarer tumours such as NB[ 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, knowledge regarding genetics of NB in the diverse ethnicities in LMICs is limited. A further challenge would be to make treatments and advanced diagnostics, such as liquid biopsies and biological tests, more widely available to all countries, whether HICs or LMICs, to improve diagnostic capacities and outcomes[ 75 ]. In advanced disease, palliative research could contribute to a greater understanding of the role of metronomic therapies and disease control in the context of NB[ 77 ].…”

Section: Resultsmentioning

confidence: 99%

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Management of neuroblastoma in limited-resource settings

Heerden

Kruger

2020

WJCO

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BACKGROUND Neuroblastoma (NB) is a heterogeneous disease with variable outcomes among countries. Little is known about NB in low- and middle-income countries (LMICs). AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries (HICs). METHODS PubMed, Global Health, Embase, SciELO, African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB, LMICs and outcomes. Only English language manuscripts and abstracts were included. A descriptive review was done, and tables illustrating the findings were constructed. RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available. The disease characteristics varied among countries for the following variables: sex, age at presentation, MYCN amplification, stage and outcome. LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs. Implementation of evidence-based treatment protocols was still a barrier to care. Many socioeconomic variables also influenced the diagnosis, management and follow-up of patients with NB. CONCLUSION Patients presented at a later age with more advanced disease in LMICs. Management was limited by the lack of resources and genetic studies for improved NB classification. Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Management of neuroblastoma in limited-resource settings

Heerden

Kruger

2020

WJCO

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“…The available literature suggests that children are more likely to present at later stages in many settings, especially when living in remote or rural regions. 44,45 To simulate this, we shifted the proportion of later stage presentations by 5% and 10% within China and Kenya. For example, we modified the base-case scenario for retinoblastoma stage distribution based on SEER data from 10% of cases presenting with advanced disease to 15% and 20%, respectively.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Forecasting essential childhood cancer drug need: An innovative model‐based approach

Hughes

Empringham

Wagner

et al. 2021

Cancer

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BACKGROUND: Childhood cancer outcomes in low-income and middle-income countries have not kept pace with advances in care and survival in high-income countries. A contributing factor to this survival gap is unreliable access to essential drugs. METHODS: The authors created a tool (FOR x ECAST) capable of predicting drug quantity and cost for 18 pediatric cancers. FOR x ECAST enables users to estimate the quantity and cost of each drug based on local incidence, stage breakdown, treatment regimen, and price. Two countryspecific examples are used to illustrate the capabilities of FOR x ECAST to predict drug quantities. RESULTS: On the basis of domestic public-sector price data, the projected annual cost of drugs to treat childhood cancer cases is 0.8 million US dollars in Kenya and 3.0 million US dollars in China, with average median price ratios of 0.9 and 0.1, respectively, compared with costs sourced from the Management Sciences for Health (MSH) International Medical Products Price Guide. According to the cumulative chemotherapy cost, the most expensive disease to treat is acute lymphoblastic lymphoma in Kenya, but a higher relative unit cost of methotrexate makes osteosarcoma the most expensive diagnosis to treat in China. CONCLUSIONS: FOR x ECAST enables needs-based estimates of childhood cancer drug volumes to inform health system planning in a wide range of contexts. It is broadly adaptable, allowing decision makers to generate results specific to their needs. The resultant estimates of drug need can help equip policymakers and health governance institutions with evidence-informed data to advance innovative procurement strategies that drive global improvements in childhood cancer drug access.

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“…The combined results of these publications from populations across sub-Saharan Africa highlight the need for improved access to care, availability of standard therapy for WT, supportive care, and patient education. These challenges remain significant and are cited as the primary determinant of decreased overall survival from WT in Africa in comparison to high-income nations (6,7,41,42). Altogether, marginalized access to less than adequate therapies for malnourished children having advanced stage, treatment-resistant WT is exceedingly difficult to overcome, hence the horrific yet consistently poor survival in certain areas of sub-Saharan Africa.…”

Section: Social Determinants Of Healthmentioning

confidence: 99%

“…However, alarming disparities in outcomes persist for children with WT residing in sub-Saharan African nations, with overall survival at 5-years as low as 25% (4). Over the past 50 years, basic descriptions of WT prevalence, treatment challenges, and poor outcomes for children living in resource-limited settings of sub-Saharan Africa have been published, with the principal focus in more recent years on social determinants of health as contributing factors to this profound cancer disparity (2,(5)(6)(7). Only in the last decade has examination of WT biology as a molecular determinant of health in these austere contexts begun to gain momentum (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Wilms Tumor in Sub-Saharan Africa: Molecular and Social Determinants of a Global Pediatric Health Disparity

Apple

Lovvorn

2020

Front. Oncol.

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Wilms tumor (WT) is the most common renal malignancy of childhood. Global disparities in WT have been reported with the highest incidence and lowest overall survival occurring in sub-Saharan African nations. After a detailed search of PubMed, we reviewed available literature on WT in sub-Saharan Africa and summarized findings that explore biologic and social factors contributing to this alarming cancer health disparity. Access to care and treatment abandonment are the most frequently reported factors associated with decreased outcomes. Implementation of multidisciplinary teams, collaborative networks, and financial support has improved overall survival in some nations. However, treatment abandonment remains a challenge. In high-income countries globally, WT therapy now is risk-stratified according to biology and histology. To a significantly lesser extent, biologic features have been studied only recently in sub-Saharan African WT, yet unique molecular and genetic signatures, including congenital anomaly-associated syndromes and biomarkers associated with treatment-resistance and poor prognosis have been identified. Together, challenges with access to and delivery of health care in addition to adverse biologic features likely contribute to increased burden of disease in sub-Saharan African children having WT. Publications on biologic features of WT that inform treatment stratification and personalized therapy in resource-limited regions of sub-Saharan Africa have lagged in comparison to publications that discuss social determinants of health. Further efforts to understand both WT biology and social factors relevant to appropriate treatment delivery should be prioritized in order to reduce health disparities for children residing in resource-limited areas of sub-Saharan Africa battling this lethal childhood cancer.

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Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Cited by 12 publications

References 45 publications

Management of neuroblastoma in limited-resource settings

Management of neuroblastoma in limited-resource settings

Forecasting essential childhood cancer drug need: An innovative model‐based approach

Wilms Tumor in Sub-Saharan Africa: Molecular and Social Determinants of a Global Pediatric Health Disparity

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