Treating childhood cancer in Rwanda: the nephroblastoma example

Abstract

IntroductionWilms tumor (WT) or nephroblastoma is the commonest childhood cancer in Rwanda. Nephroblastoma is regarded as one of the successes of pediatric oncology with long-term survival approaching 90%. The Objectives to evaluate the feasibilityof treating childhood cancer using the nephroblastoma example and to calculate its cost of treatment in Rwanda.MethodsProspective study over a 2 year period: 01 Jan 2010- 31 December 2011. A questionnaire was completed by all participants in the study and the following variables were collected at Kigali University Teaching Hospital: age at diagnosis, gender, transport cost, cost of investigations, staging, treatment and outcome, cost of hospitalization, type of medical, surgical, radiological interventions and their costs, number of admissions per patient and factors related to non compliance to treatment. All patients had a confirmed diagnosis on histopathology examination. The cost for treatment was calculated for early and late stage and was expressed in USA dollars. Analysis was done with SPSS 16.0.ResultsThere were 25 patients diagnosed and treated for WT during the study period. Almost half of the patients 14/25 (56%) had advanced disease, seven children (28%) had stage IV, seven children stage III, six patients (24%) with stage II, while the remaining five (20%) had stage I with high risk tumor. The direct cost of management ranged from1,831.2 USD for early disease to 2,418.7 USD for advanced disease. The cost of transport, investigations and drugs were recorded as main contributing factors to the feasibility and cost of the treatment in 80% of the responses, followed by late presentation (56%) and poor compliance to treatment.ConclusionMost challenges are related to unaffordable treatment and late presentation. The management of WT is feasible in Rwandan setting but efforts should be made in order to improve awareness of childhood cancer, early diagnosis and access to care. The government of Rwanda is committed to improve cancer care in the country and organized the first pediatric international oncology conference in Kigali, in March 2012 to develop National protocols for the top five most common cancers in children.

Continuing barriers to care of Wilms tumor in a low‐income country

“…This is evidenced by the long duration of symptoms before presentation, absence of stage 1 disease in all of our series, and more than 80% of our cases with advanced disease at presentation. Though similar delayed presentation has been reported in some other developing countries, it contrasts sharply with the situation in more developed countries where most patients have early disease at presentation . Late presentation is associated with complications of the disease, and coupled with the coexisting morbidities in our setting will require more intensive care, which unfortunately is also lacking.…”

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

“…After adjusting for duplicates, 2001 studies remained. Of these, 30 studies met full inclusion criteria 16–18 29–55. The kappa measure of agreement between the two reviewers was 0.71 (95% CI 0.55 to 0.86).…”

A systematic review of factors that influence treatment adherence in paediatric oncology patients

“…A total of three factors were identified under the social/economic category. The number of studies and the type of studies that support each factor are shown in Table …”

“…Notably, several studies highlighted that a lack of affordable transportation can negatively impact adherence to treatment. This factor featured prominently in patients coming from rural areas of developing countries, especially those from the lower socio‐economic classes …”