Treatment of retinoblastoma in Sub‐Saharan Africa: Experience of the paediatric oncology unit at Gabriel Toure Teaching Hospital and the Institute of African Tropical Ophthalmology, Bamako, Mali

Traoré, Fousseyni; Sylla, Fatou K.; Togo, Boubacar; Bakarou, Kamaté; Konimba, Diabaté; Diakité, Abdoul Aziz; Diall, Hawa; Dicko, Fatoumata; Sylla, Mariam; Bey, P.; Desjardins, Laurence; Gagnepain-Lacheteau, Anne; Coze, Carole; Harif, Mhamed; Doz, François

doi:10.1002/pbc.27101

Cited by 25 publications

(22 citation statements)

References 40 publications

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“…This provides some confirmation of the quality of the data and the face validity of the staging criteria applied in our study. Some data on stage‐specific survival for childhood cancers are available from other African studies, 15,16,19,20 although comparisons with our results are difficult because of the different staging systems used, highlighting the importance of a consistent approach.…”

Section: Discussionmentioning

confidence: 84%

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub‐Saharan Africa

Parkin

Youlden

Chitsike

et al. 2021

Intl Journal of Cancer

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The lack of accurate population‐based information on childhood cancer stage and survival in low‐income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population‐based registries in sub‐Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non‐Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed‐up, allowing calculation of 3‐year relative survival by cancer type and registry. Stage‐specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three‐year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%‐33%] for BL in Harare to 57% (95% CI = 31%‐76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3‐year observed survival was 88% (95% CI = 68%‐96%) and 13% (4%‐29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage‐specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low‐resource setting and highlight the value of population‐based cancer registries in aiding our understanding of the poor outcomes experienced by this population.

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Section: Discussionmentioning

confidence: 84%

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub‐Saharan Africa

Parkin

Youlden

Chitsike

et al. 2021

Intl Journal of Cancer

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“…The topics covered are similar to most pediatric oncology training programs available globally, but the content of the DUCP curriculum was specifically adapted to African LMICs by prioritizing the most curable diseases encountered in these countries, focusing on supportive care, and developing the multidisciplinary team. The curriculum emphasized the importance of using adapted protocols, such as GFAOP-adapted protocols, 13,14 International Society of Paediatric Oncology Paediatric Oncology in Developing Countries protocols, 15 and other published protocols with a proven record in LMICs. 16 Other issues specific to pediatric oncology in LMICs, such as treatment abandonment, early diagnosis, and coping with limitations in resources, were also addressed.…”

Section: Resultsmentioning

confidence: 99%

African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa

Hessissen

Patte

Martelli

et al. 2019

JGO

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PURPOSE In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries. METHODS A 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training. RESULTS The first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site. CONCLUSION This training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.

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“…Initiatives are addressing this need by creating twinning programs that link centers from higher-and lower-resource countries, as well as interventions such as public awareness campaigns, and health worker education. [29,31,[35][36][37][38][39] There is a pressing need, to promote this action at national and global level. In a rare curable cancer such as Rb, with a finite number of patients worldwide, such action is feasible.…”

Section: Discussionmentioning

confidence: 99%

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

et al. 2020

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BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.ConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

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Treatment of retinoblastoma in Sub‐Saharan Africa: Experience of the paediatric oncology unit at Gabriel Toure Teaching Hospital and the Institute of African Tropical Ophthalmology, Bamako, Mali

Cited by 25 publications

References 40 publications

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub‐Saharan Africa

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub‐Saharan Africa

African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

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