Strategies to improve care for children with cancer in Sub-Saharan Africa |
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| Authors: | Trijn Israels Raul C Ribeiro Elizabeth M Molyneux |
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| Institution: | 1. Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi;2. Department of Paediatric Oncology, Emma Children’s Hospital/AMC, Amsterdam, The Netherlands;3. Department of Oncology and International Outreach Program, St. Jude Children’s Research Hospital, Memphis, TN, USA;1. Dept of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana;2. Dept of Paediatric Oncology, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia;3. Dept of Paeds Oncology, Uganda Cancer Institute, Kampala, Uganda,;4. Dept of Child Health, University of Ghana Medical School, Accra, Ghana;5. Dept of Paediatric Oncology, Mbingo Baptist Hospital, Cameroon;6. Acad Unit of Paediatric and Adolescent Oncology, University of Manchester, UK;7. Dept of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa;8. Dept of Paediatrics, College of Medicine, Blantyre, Malawi;9. Dept of Paediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands;10. Co-chair International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC);1. Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan-Kettering Cancer Center, NY, USA;2. Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria;3. National Centre of Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana;4. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA;5. Department of Surgery, School of Medical Sciences, Komfo Anokye Teaching Hospital, Kumasi, Ghana;6. Department of Surgery, Connaught Hospital, University of Sierra Leone, Freetown, Sierra Leone;7. Center for Clinical Cancer Genetics and Global Health, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA;8. Department of Radiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria;9. Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria;10. Department of Obstetrics and Gynaecology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa;1. Laboratory of Experimental Immunology, Cancer and Inflammation Program, National Cancer Institute at Frederick, Frederick, MD 21702, USA;2. Universidad de San Carlos Medical School, Guatemala City, Guatemala;3. Leidos Biomedical Research Corporation, Frederick, MD 21702, USA;4. Stanford University, Stanford, CA 94305, USA;5. Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala;6. Laboratory of Immunogenomic and Metabolic Diseases, National Institute of Genomic Medicine, Mexico City, Mexico;7. Pediatric Hematology/Oncology/SCT/Cancer Bio, Stanford University School of Medicine, Stanford, CA 94305, USA;1. Center for Health Decision Science, Harvard Medical School, Harvard University, Boston, MA, USA;2. Department of Global Health and Population, Harvard Medical School, Harvard University, Boston, MA, USA;3. Harvard T H Chan School of Public Health, and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA;4. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA;5. Division of General Pediatrics, Boston Children''s Hospital, Boston, MA, USA;6. Department of Global Pediatric Medicine, St Jude Children''s Research Hospital, Memphis, TN, USA;7. Dana-Farber/Boston Children''s Cancer and Blood Disorders Center, Boston, MA, USA;8. Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;1. Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, King''s College London, London, UK;2. African Palliative Care Association, Kampala, Uganda;3. Palliative Care Unit, Makerere University, Kampala, Uganda;4. Hospice Africa Uganda, Kampala, Uganda;5. Kenyan Hospices and Palliative Care Association, Nairobi, Kenya;6. University of Cape Town, Cape Town, South Africa |
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| Abstract: | Great progress has been made in the care of children with cancer in recent decades. Worldwide, more than 80% of children with cancer live in resource-limited countries where access to care is poor. Sub-Saharan Africa is the world’s poorest region. Child mortality is high, caused by largely preventable and treatable conditions. Paediatric cancer accounts for only a small fraction of deaths and understandably receives little attention from local policy makers or global health agencies. The survival of children with cancer is very poor. Challenges to improving survival include advanced-stage disease at presentation, failure to start or complete treatment (abandonment), inadequate hospital infrastructure and medications, lack of trained health care providers, lack of cancer registration and follow-up and lack of treatment guidelines adapted to local medical facilities. We propose a stepwise approach that integrates paediatric cancer treatment with existing general paediatric care. Priority is given to interventions (improvement of supportive care, diagnostic facilities) that also improve general paediatric care. Minimal requirements for diagnostic procedures include complete blood counts, HIV and malaria tests, blood cultures, histopathology and simple imaging (X-ray and ultrasonography). Feasible interventions include adequate palliative care, curative treatment for Burkitt lymphoma and Wilms tumour and symptomatic treatment for Kaposi sarcoma. |
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