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Multicenter Study
. 2024 Aug;71(8):e31069.
doi: 10.1002/pbc.31069. Epub 2024 May 21.

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa

Barnabas Atwiine  1 , Cecilia Mdoka  2 , Mushabe Branchard  1 , George Chagaluka  3 , Diriba Fufa  4 , Mulugeta Ayalew  5 , Harriet Khofi  2   3 , Emmanuel Amankwah  6 , Nester Chokwenda  7 , Feven Birhane  5 , Esubalew Mezgebu  4 , Bernice Eklu  8 , Brian Jator  9 , Evaristar Kudowa  10 , Glenn Mbah  9 , Mulugeta Wassie  5 , Vongai Dondo  7 , Vivian Paintsil  8 , Kathy Pritchard-Jones  11 , Lorna Awo Renner  6 , Lillian Sung  12 , Francine Kouya  9 , Elizabeth Molyneux  3 , Inam Chitsike  7 , Trijn Israels  2   3
Affiliations
Multicenter Study

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa

Barnabas Atwiine et al. Pediatr Blood Cancer. 2024 Aug.

Abstract

Background: The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I.

Methods: Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites.

Results: We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar.

Conclusion: Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.

Keywords: Africa; Wilms tumor; nephroblastoma; resource‐limited settings; survival; treatment abandonment.

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References

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