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Establishing a Pediatric Hematology-Oncology Program in Botswana
Jeremy S Slone1, Amanda K Slone1, Oaitse Wally1
1Jeremy S. Slone, Amanda K. Slone, Kamusisi Chinyundo, Judith Margolin, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Texas Children's Cancer and Hematology Centers; Jeremy S. Slone, Amanda K. Slone, Susan Alisanski, Lisa M. Force, Kamusisi Chinyundo, Judith Margolin, Anurag K. Agrawal, Alan R. Anderson, Michael E. Scheurer, and Parth S. Mehta, Baylor College of Medicine, Houston, TX; Oaitse Wally, University of Botswana; Oaitse Wally, Pearl Semetsa, and Mpho Raletshegwana, Princess Marina Hospital, Gaborone, Botswana; and Anurag K. Agrawal, Children's Hospital and Research Center, Oakland, CA.
Insights
Pediatric cancer survival in Botswana reached 52.4% over two years, demonstrating successful diagnosis and treatment for childhood cancers through a collaborative program. This highlights progress in managing pediatric malignancies in low-resource settings.
Area of Science:
- Pediatric Oncology
- Global Health
- Cancer Epidemiology
Background:
- 300,000 children diagnosed with cancer annually, predominantly in low- and middle-income countries (LMICs).
- Limited data exists on pediatric cancer incidence, diagnosis, and outcomes in Africa.
- A pediatric hematology-oncology program established in Botswana in 2007 through international partnership.
Purpose of the Study:
- To assess patient characteristics and treatment outcomes at Botswana's sole pediatric cancer program.
- To establish a hospital-based database, the Botswana Pediatric Oncology Database, for comprehensive data collection.
- To analyze data from children diagnosed between 2008 and 2015.
Main Methods:
- Utilized the Botswana Pediatric Oncology Database, established in 2014.
- Included children under 18 diagnosed between 2008 and 2015.
- Extracted data in February 2016 for 185 eligible children (77% of potential enrollees).
Main Results:
- Leukemia was the most frequent malignancy (18.9%); 88.1% had histopathologic diagnosis.
- HIV seropositivity was present in 13.5% of the pediatric cancer cohort.
- The 2-year overall survival rate for all pediatric cancers was 52.4%; treatment abandonment was 3.8%.
Conclusions:
- A Botswana-based pediatric cancer program, supported by international partnerships, has successfully provided care for children with cancer and blood disorders.
- Outcomes demonstrate that children with cancer in Botswana can be effectively diagnosed and treated.
- Continued improvements are necessary, but current results show significant progress in pediatric oncology care in LMICs.
Purpose:
Annually, 300,000 children are diagnosed with cancer, and the majority of these children live in low- and middle-income countries (LMICs). Currently, there is incomplete information on pediatric cancer incidence, diagnosis distribution, and treatment outcomes in Africa. Since 2007, a pediatric hematology-oncology program has been operating in Botswana through a partnership between the Botswana government, Baylor College of Medicine, and Texas Children's Hospital.
Methods:
To better understand patient characteristics and outcomes at Botswana's only pediatric cancer program, a hospital-based data base-the Botswana Pediatric Oncology Database-was established in 2014. Children younger than 18 years of age at the time of diagnosis who presented between 2008 and 2015 were included. Data for this study were extracted in February 2016.
Results:
Of the 240 potential enrollees, 185 (77%) children met eligibility for this study. The median age was 6.4 years, and 50.8% were male. Leukemia was the most common malignancy representing 18.9% of the cohort and 88.1% of the total cohort had a histopathologic diagnosis. HIV seropositivity was confirmed in 13.5%. The 2-year overall survival of all pediatric cancer diagnoses was 52.4%. Abandonment of treatment occurred in 3.8% of patients.
Conclusion:
In the first 9 years of the program, capacity has been developed through a longstanding partnership between Botswana and Baylor College of Medicine/Texas Children's Hospital that has led to children receiving care for cancer and blood disorders. Although continued improvements are necessary, outcomes to date indicate that children with cancer in Botswana can be successfully diagnosed and treated.
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