Childhood Cancer in Africa – Part 2
In striving to address the scourge of Childhood Cancer in Africa, we need to understand everything we can about Childhood Cancer in Africa; how it is diagnosed, how it is treated, why the mortality rate is so high, and any other factors that could hamper cure or survival rates.
Throughout the continent, patterns of malignant disease vary with an obvious increase in the prevalence of Burkitt lymphoma (BL) and Kaposi sarcoma in response-increased prevalence of HIV disease.
Africa bears a great burden of childhood cancer. Cancer is now curable in developed countries as survival rates approach 80%, but in Africa, more than 80% of children still die without access to adequate treatment.
Infections and Childhood Cancer in Africa
According to UNICEF, 1 in 10 children born in sub-Saharan Africa die before their 5th birthday – at least 50% of these deaths are due to four major infections: pneumonia (18%); malaria (17%); diarrhoea (12%); and HIV/AIDS (3%).
Progress in treatment regimens between 1990 and 2012 in sub-Saharan Africa have led to a reduction in U5MR of 45%. Children with Cancer often succumb to common and largely preventable infections; this could pose an obstacle to the successful delivery of Childhood Cancer Care.
90% of deaths from malaria occur in sub-Saharan Africa, mostly among young children. While this introduces another cause for pyrexia in myelo-suppressed patients, impacting on case management in childhood cancer care, evidence suggests that cancer patients are no more likely to have a fatal episode than are other children.
Infections have impacted on the survival of children receiving cancer care in Africa, but have also shaped the burden of malignant disease:
- Malaria and EBV cooperate to produce endemic BL;
- The HIV/AIDS epidemic has resulted in an increase in HIV-associated malignancies, particularly Kaposi Sarcoma, which was already endemic in some areas due to a high prevalence of human herpes virus 8 (HHV8);
- Endemic BL occurs in children under 15 in the ‘lymphoma belt’, which corresponds geographically with the malaria belt;
- The ability of Epstein–Barr virus (EBV), especially in respect of infections that occur early in life, to transform lymphocytes by inducing the translocations typically found in BL, appears to be augmented by the intensity of malarial parasitaemia.
While there is minimal evidence that the HIV/AIDS epidemic has led to a significant increase in BL in areas where it commonly occurs, there has been an increase in areas where sporadic Burkitt’s lymphoma (BL) occurs, such as South Africa. By contrast, there has been a major increase in the incidence of HHV8-driven Kaposi Sarcoma – outcomes for both remain generally poor as a result of advanced presentation and multiple co-morbidities. The rollout of highly active anti-retroviral therapy (HAART) is decreasing mother-to-child transmission, and improving outcomes for HIV-infected Children with Cancer.
The high tuberculosis incidence rate in children with cancer is a confounding co-morbidity which can lead to diagnostic confusion, especially in HIV-infected patients. Patients who have both tuberculosis and HIV, a potentially lethal combination, the predicted outcome is poor and the potential for multiple-drug interactions high.
Childhood Cancer Treatment in Africa
Paediatric Oncology Units (POUs) are established in South Africa, North Africa and certain African countries.
According to a survey conducted in Africa, 14 out of 48 countries provide some form of dedicated paediatric oncology service, with either a paediatric oncologist or paediatrician providing medical care.
The median of newly diagnosed patients per annum (with a range of 5–500) is reported as 88 children newly diagnosed per annum. Other figures reported as the number of patients per annum (ppa) are:
- Tanzania (>500 ppa)
- Uganda (380 ppa)
This exemplifies the stark contrast between high patient numbers and poor medical staffing numbers, with eight and four doctors per unit, respectively. In addition, a centre in Uganda reported nurse-patient ratios of 1:15 during the day, and 1:45 at night.
As far as allied medical professionals go, there is a critical shortage of physiotherapists, social workers, and occupational therapists, but 49% reported good capacity to treat children with cancer. All the respondents indicated access to either subsidised or unsubsidised chemotherapy; 66% had no access to radiotherapy, and only 26% have limited access to diagnostic pathology laboratories. 65% have a dedicated ward and 52% use local tumour registries.
Twinning initiatives between Paediatric Oncology Units in low- and medium-income countries and a developed country introduced successful treatment programmes in Cameroon, Malawi, Mali and Senegal.
In a successful twinning programme, which is led by the local health-care team to ensure sustainability, the local health-care team:
- Needs to recognise the need to offer childhood cancer treatment;
- Should have strong medical and/or nursing leadership;
- Should have the support of both the hospital policymakers and the local community;
- Should have access to external funding and international expert partners.
Twinning programmes often rely on non-governmental organisations (NGOs) to fund-raise for essential cancer medicines, whereas local health-care staff are trained in paediatric cancer care.
Published data from African collaborative studies is scarce and overall survival rates varied from 5% to 80%, with most reports coming from single-unit treatment centres.
The Franco-African Childhood Cancer Group (GFAOP) is the first collaborative group in Africa, founded in 2000, with the aim of providing paediatric cancer treatment. GFAOP’s action plans included the training of medical personnel from Francophone countries in Africa, and the establishment of joint clinical trials with treatment protocols for common childhood cancers.
In excess of 1,000 children were treated in African hospitals between 2001 and 2007, creating the necessary expertise to treat children with cancer. The outcome of GFAOP’s first collaborative clinical trials for BL and other B cell lymphomas, nephroblastoma and pain management had a 61% survival rate. GFAOP supplies medications where necessary, and provides financial support to physicians and nurses to enable them to attend workshops and conferences.
Source: Childhood Cancer in Africa
We will post Part 3 of Childhood Cancer in Africa tomorrow
Posted on 19 February, 2016, in Blog and tagged Africa; cancer; children; diagnosis; epidemiology; management. Bookmark the permalink. Leave a comment.