The My Child Matters programme: effect of public–private partnerships on paediatric cancer care in low-income and middle-income countries

Howard, Scott C.; Zaidi, Alia; Cao, Xueyuan; Weil, Olivier; Bey, P.; Patte, Catherine; Samudio, Angélica; Haddad, Laurie; Lam, Catherine G.; Moreira, C.; Pereira, Alamanda Kfoury; Harif, Mhamed; Hessissen, Laïla; Choudhury, Salma; Fú, Ligia; Caniza, Miguela; Lecciones, Julius; Traoré, Fousseyni; Ribeiro, Raul C.; Gagnepain-Lacheteau, Anne

doi:10.1016/s1470-2045(18)30123-2

Cited by 106 publications

(143 citation statements)

References 60 publications

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“…The frequency distribution of causes of treatment failure in low‐income countries differs from those in high‐income settings 10 . These causes include abandonment of treatment, death during treatment and disease‐related causes such as unresectable disease or relapse of disease.…”

Section: Discussionmentioning

confidence: 99%

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Chagaluka

Paintsil

Renner

et al. 2020

Pediatric Blood & Cancer

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Introduction The Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub‐Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event‐free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation. Methods The Collaborative WT Africa Project is a multi‐centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described. Results In total, 201 WT patients were included. Two‐year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. Programme implementation was associated with significantly higher survival without evidence of disease at the end of treatment (52% vs 68.5%, P = .002), significantly reduced abandonment of treatment (23% vs 12%, P = .009) and fewer deaths during treatment (21% vs 13%, P = .06). Conclusion This collaborative implementation of an adapted WT treatment guideline, using relatively simple and low‐cost interventions, was feasible. Two‐year EFS was almost 50%. In addition, a significant decrease in treatment abandonment and an increase in survival at the end of treatment were observed compared to a pre‐implementation cohort. Future work should focus on decreasing deaths during treatment and will include enhancing supportive care.

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Section: Discussionmentioning

confidence: 99%

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Chagaluka

Paintsil

Renner

et al. 2020

Pediatric Blood & Cancer

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“…However, implementing this intensive strategy involves overcoming many challenges at each step, and in many low‐income countries (LIC) it is simply not feasible, and lower dose regimens are the only alternative (Depani et al , ; Buckle et al , ; Stanley et al , ). Although such regimens yield EFS lower than the 90% achieved in HIC, they allow a subset of patients to be cured without excess toxicity and are feasible even in the most basic healthcare systems (Howard et al , ,b, , ).…”

Section: Protocol‐based Carementioning

confidence: 99%

“…In some cases, 2–5% of patients died within a few hours of arrival to the hospital before even completing staging evaluation (Moleti et al , ; Gaytan‐Morales et al , ). Extensive abdominal surgical procedures as well as nutritional deficiencies in some settings may also increase the risk of early toxicity, and chemotherapy dose modifications may be necessary in these cases (Israels et al , ; Traore et al , ; Cervio et al , ; Patte et al , ; Pribnow et al , ; Howard et al , ). Delayed diagnosis with advanced disease not only increases the risk of toxic death and excess relapse, but also increases the costs and morbidity of treatment, which in turn increases the rate of abandonment of therapy.…”

Section: Management Of Burkitt Lymphoma In Low‐ and Middle‐income Coumentioning

confidence: 99%

Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment

2019

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In high-income countries, more than 90% of children with mature B-cell lymphomas are cured with frontline therapy. However, cure requires prompt and correct diagnosis, careful risk stratification, very intense chemotherapy and meticulous supportive care, together with logistical support for patients who live far from the cancer centre or face financial barriers to receiving care. In low-and middle-income countries (LMIC), cure rates range from 20% to 70% because of lack of diagnosis, misdiagnosis, abandonment of treatment, toxic death and excess relapse with reduced-intensity regimens. Fortunately, a wide range of successful interventions in LMIC have reduced these causes of avoidable treatment failure. Public awareness campaigns have led to societal awareness of childhood cancer; telepathology has improved diagnosis, even in remote areas; subsidized chemotherapy, transportation, housing and food have reduced abandonment; and hand hygiene, nurse training programmes and health system improvements have reduced toxic death. These interventions can be deployed everywhere and at low cost, so are highly scalable. Children and adolescents with Burkitt lymphoma can be cured in all countries by making a timely correct diagnosis, applying protocols adapted to the local context, preventing abandonment of therapy and avoiding toxic death. Reducing these causes of treatment failure is feasible and highly cost-effective everywhere.

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“…Survival of children with cancer in high‐income countries has much improved in recent decades and is now, on average, around 70% 1 . Survival in low‐income countries (LICs) is much lower and in several countries in sub‐Saharan Africa is estimated to be below 20% 2 . Several initiatives have reported that many children with cancer in Africa can be cured 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Outcome at the end of treatment of patients with common and curable childhood cancer types in Blantyre, Malawi

Chakumatha

Weijers

Banda

et al. 2020

Pediatric Blood & Cancer

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The My Child Matters programme: effect of public–private partnerships on paediatric cancer care in low-income and middle-income countries

Cited by 106 publications

References 60 publications

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Improvement of overall survival in the Collaborative Wilms Tumour Africa Project

Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment

Outcome at the end of treatment of patients with common and curable childhood cancer types in Blantyre, Malawi

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