Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub‐Saharan Africa. Issue 11 (2nd February 2021)

• Record Type: Journal Article
• Authors: Parkin, Donald Maxwell; Youlden, Danny R.; Chitsike, Inam; Chokunonga, Eric; Couitchéré, Line; Gnahatin, Franck; Nambooze, Sarah; Wabinga, Henry; Aitken, Joanne F.
• Is Part Of: International journal of cancer. Volume 148:Issue 11(2021)
• Page Start: 2685
• Page End: 2691
• Publication Date: 2021-02-02
• Subjects: childhood cancers -- registry -- stage -- sub‐Saharan Africa -- survival; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33468
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: 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. Abstract : What's new? To improve child cancer survival rates in sub‐Saharan Africa, the first step must be to collect accurate data on incidence and survival. The Toronto Stage Guidelines are a tool to internationally standardize the collection of data on stage of diagnosis of childhood cancers. Here, the authors examined data from three population‐based registries on children under 15, and determined that cancer stage at diagnosis was a strong predictor of survival, highlighting the value of population‐based registries. The Toronto Stage Guidelines were shown to be feasible for use in a low‐resource setting to assess cancer stage at diagnosis.