Trijn Israels1,2, Vivian Paintsil3, Dalida Nyirenda4, Francine Kouya5, Glenn Mbah Afungchwi6, Peter Hesseling7, Clara Tump8, Gertjan Kaspers1,9, Liz Burns10, Ramandeep Singh Arora11, George Chagaluka4, Philippa Nana5, Lorna Renner12, Elizabeth Molyneux4. 1. Academy outreach and Department of solid tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands. 2. Department of Paediatrics, Amphia Hospital, Breda, The Netherlands. 3. Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana. 4. Department of Paediatrics, College of Medicine, Blantyre, Malawi. 5. Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, Cameroon. 6. Department of Paediatrics, Banso Baptist Hospital, Banso, Cameroon. 7. Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. 8. Department of Artificial Intelligence, University of Amsterdam, Amsterdam, The Netherlands. 9. Department of Paediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands. 10. Head of Operations, World Child Cancer, London, United Kingdom. 11. Department of pediatric oncology, Max Super-Specialty Hospital, New Delhi, India. 12. Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana.
Abstract
BACKGROUND: The Collaborative Wilms Tumour (WT) Africa Project has implemented an adapted WT treatment guideline in sub-Saharan Africa as a multi-centre prospective clinical trial. A retrospective, baseline evaluation of end-of-treatment outcome was performed for a 2-year period prior to the introduction of this guideline. The collaborative project aims to reduce both treatment abandonment and death during treatment to less than 10% for improving survival. PROCEDURE: All participating centres obtained local Institutional Research Board (IRB) approval and implemented the adapted WT treatment guideline. End-of-treatment outcome was documented for 2 years. It was divided into alive without evidence of disease, treatment abandonment, death during treatment and persistent disease. The outcome of children enroled in the first 2 years of the prospective clinical trial has been compared to the outcome before the start of the project. RESULTS: One hundred twenty-two patients were included in the baseline evaluation (2011-2012) and 133 in the first 2 years of the collaborative clinical trial (2014-2015). The percentage of patients alive without evidence of disease at the end of treatment increased from 52% (63/122) to 68% (90/133; P = 0.01). Treatment abandonment decreased from 23% (28/122) to 13% (17/133; P = 0.03). Death during treatment decreased from 21% (26/122) to 13% (17/133; P = 0.07). CONCLUSION: This collaboration, using relatively simple and low-cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment.
BACKGROUND: The Collaborative Wilms Tumour (WT) Africa Project has implemented an adapted WT treatment guideline in sub-Saharan Africa as a multi-centre prospective clinical trial. A retrospective, baseline evaluation of end-of-treatment outcome was performed for a 2-year period prior to the introduction of this guideline. The collaborative project aims to reduce both treatment abandonment and death during treatment to less than 10% for improving survival. PROCEDURE: All participating centres obtained local Institutional Research Board (IRB) approval and implemented the adapted WT treatment guideline. End-of-treatment outcome was documented for 2 years. It was divided into alive without evidence of disease, treatment abandonment, death during treatment and persistent disease. The outcome of children enroled in the first 2 years of the prospective clinical trial has been compared to the outcome before the start of the project. RESULTS: One hundred twenty-two patients were included in the baseline evaluation (2011-2012) and 133 in the first 2 years of the collaborative clinical trial (2014-2015). The percentage of patients alive without evidence of disease at the end of treatment increased from 52% (63/122) to 68% (90/133; P = 0.01). Treatment abandonment decreased from 23% (28/122) to 13% (17/133; P = 0.03). Death during treatment decreased from 21% (26/122) to 13% (17/133; P = 0.07). CONCLUSION: This collaboration, using relatively simple and low-cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment.
Authors: Wilfred Ngwa; Beatrice W Addai; Isaac Adewole; Victoria Ainsworth; James Alaro; Olusegun I Alatise; Zipporah Ali; Benjamin O Anderson; Rose Anorlu; Stephen Avery; Prebo Barango; Noella Bih; Christopher M Booth; Otis W Brawley; Jean-Marie Dangou; Lynette Denny; Jennifer Dent; Shekinah N C Elmore; Ahmed Elzawawy; Diane Gashumba; Jennifer Geel; Katy Graef; Sumit Gupta; Serigne-Magueye Gueye; Nazik Hammad; Laila Hessissen; Andre M Ilbawi; Joyce Kambugu; Zisis Kozlakidis; Simon Manga; Lize Maree; Sulma I Mohammed; Susan Msadabwe; Miriam Mutebi; Annet Nakaganda; Ntokozo Ndlovu; Kingsley Ndoh; Jerry Ndumbalo; Mamsau Ngoma; Twalib Ngoma; Christian Ntizimira; Timothy R Rebbeck; Lorna Renner; Anya Romanoff; Fidel Rubagumya; Shahin Sayed; Shivani Sud; Hannah Simonds; Richard Sullivan; William Swanson; Verna Vanderpuye; Boateng Wiafe; David Kerr Journal: Lancet Oncol Date: 2022-05-09 Impact factor: 54.433