Significant Impact of Treatment Abandonment on Survival of Children With "Common and Curable" GICC Index Cancers in Sub-Saharan Africa-A Multicenter Prospective CANCaRe Africa Study.

BACKGROUND

The World Health Organization Global Initiative for Childhood Cancer (GICC) targets a global survival rate of 60% for childhood cancer, focusing initially on six common, curable cancers. This study describes survival rates of five of these cancers in sub-Saharan Africa and assesses the impact of treatment abandonment (TxA).

METHODS

This multicenter, prospective, observational cohort study included newly diagnosed children (<16 years) with Burkitt lymphoma (BL), acute lymphoblastic leukemia (ALL), Wilms tumor (WT), retinoblastoma (RB), or Hodgkin lymphoma (HL), enrolled between January and December 2022 from seven hospitals in Malawi, Ethiopia (n = 2), Ghana, Kenya, Uganda, and Cameroon. Two-year event-free survival (EFS) and treatment abandonment rates were analyzed.

RESULTS

Of 366 patients enrolled (median age 7.0 years, 64% males), Burkitt lymphoma was most common (30%, 108/366). Median follow-up was 27.6 months (range: 8-37.4). Treatment abandonment occurred in 24% of patients (89/366), highest in RB patients (38%, 15/39). Overall 2-year EFS was 40.8% ± 2.7%, improving to 59.2% ± 3.0% when TxA cases were censored. EFS rates with TxA as an event were BL 39.1% ± 5.0%, ALL 27.4% ± 4.4%, WT 51.5% ± 5.4%, RB 39.9% ± 8.0%, and HL 68.5% ± 9.3%.

CONCLUSION

Survival for common, curable childhood cancers in sub-Saharan Africa remains low, averaging approximately 41% at 2 years, ranging from 27% (ALL) to 69% (HL). Treatment abandonment significantly impacts outcomes, affecting nearly 25% of patients. Preventing abandonment could potentially increase average survival to approximately 60%, emphasizing the need for effective intervention strategies.