The feasibility of implementing Toronto childhood cancer stage guidelines and estimating the impact on outcome for childhood cancers in seven pediatric oncology units in sub-Saharan Africa. A study from the Franco-African Pediatric Oncology Group |
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| Authors: | Brenda Mallon Rolande Kaboré Line Couitchere Fatou Binetou Akonde Mbolanirina Lala Rakotomahefa Narison Aléine Budiongo Tankélé Arsène Dackono Angel Pondy Francis Diedhiou Catherine Patte Eva Steliarova-Foucher Jacqueline Clavel |
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| Institution: | 1. Groupe Franco-Africain d'Oncologie Pédiatrique (GFAOP) Gustave Roussy Villejuif, Villejuif, France;2. Service d'oncologie pédiatrique, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso;3. Unité d'oncologie pédiatrique, Hôpital de Treichville, Abidjan, Ivory Coast;4. Unité d'oncologie pédiatrique, Hôpital Aristide Le Dantec, Dakar, Senegal;5. Unité d'oncologie pédiatrique, CHU JRA Antananarivo, Antananarivo, Madagascar;6. Unité d'oncologie pédiatrique, Cliniques Universitaires de Kinshasa, Kinshasa, Congo;7. Unite d'Oncologie Pédiatrie, CHU Gabriel Touré de Bamako, Bamako, Mali;8. Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun;9. Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France;10. INSERM UMRS-1153 - EPICEA Epidémiologie des Cancers de l'Enfant et de l'Adolescent, Paris, France |
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| Abstract: | Background The improvement of childhood cancer outcome is determined by early diagnosis, effective treatment, supportive care, and adequate medical follow-up. Stage at diagnosis may reflect timeliness of diagnosis, therefore standardized registration of stage is essential for interpretation of regional differences and time trends in survival. Here, we describe the feasibility of implementing the Toronto Childhood Cancer Stage Guidelines (hereafter Toronto Guidelines TG]) in the hospital-based cancer registry of the Franco-African Pediatric Oncology Group (GFAOP), and assess the impact of TG stage on outcome in pediatric oncology units (POUs) in seven low- and middle-income countries in sub-Saharan Africa (SSA). Methods All cancer patients diagnosed before 15 years of age with one of the 15 cancer types defined in TG, resident in one of the participating countries, and attending one of the selected POUs in 2017–2019 were included. Stage was assigned according to TG. Patients were followed-up for vital status for at least 12 months post diagnosis. Survival at 3, 6, and 12 months was calculated using Kaplan–Meier method and compared between POUs and tumor groups using log-rank test. Results TG stage was assigned to 1772 of 2446 (89%) cases diagnosed with one of 11 cancer types. It was not possible to assign TG stage to acute lymphoblastic leukemia (ALL) and the three types of the central nervous system tumors included in the TG. One-year overall survival (OS) was 58% 95% confidence interval: 55–60] and varied between POUs. Survival declined with increasing stage for four tumor types and was statistically significant for two. Conclusion Except for ALL and brain tumors, we demonstrated feasibility of TG implementation for childhood solid cancers in participating POUs in SSA, and provided a baseline assessment of childhood cancer outcomes against which future stage distribution and survival can be measured as timelines of diagnosis improve over time within the GFAOP network. |
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| Keywords: | childhood cancers GFAOP LMIC registry stage sub-Saharan Africa |
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