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Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study
K Ford1, S Gunawardana2, E Manirambona3
1Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
Insights
Global health disparities in childhood cancer are evident. A medical student-led collaboration comparing Wilms' tumour (WT) outcomes in low- and high-income countries highlights significant survival differences and the need for improved services.
Area of Science:
- Global Health
- Pediatric Oncology
- Medical Education
Background:
- Childhood cancer research and treatment remain under-resourced globally.
- The Oxford Pediatrics Linking Oncology Research with Electives initiative fostered collaboration between low- and high-income pediatric surgery and oncology centers.
- This study focuses on the development of a medical student-led research network and the outcomes of Wilms' tumour (WT).
Purpose of the Study:
- To describe the development of a novel, student-led, international research collaboration in pediatric oncology.
- To report on the clinical outcomes of Wilms' tumour (WT) patients treated in collaborating centers across different income settings.
- To evaluate the feasibility and effectiveness of a global research network model involving medical students.
Main Methods:
- A cross-sectional, observational study adhering to STROBE guidelines.
- Collaboration involved three tertiary hospitals in Tanzania, Rwanda, and the UK.
- Medical students conducted retrospective patient note reviews over two years using a standardized data collection tool, with survival as the primary outcome.
Main Results:
- 104 Wilms' tumour (WT) cases were reported: 71 in Tanzania, 26 in Rwanda, and 7 in the UK.
- Survival rates were significantly higher in the high-income UK center (100%) compared to Tanzania (87%) and Rwanda (92%).
- Disease presentation was more advanced in Tanzania, and post-operative morbidity was higher in lower-resourced settings, despite comparable age at presentation and pre-operative chemotherapy.
Conclusions:
- Medical student involvement in global research collaborations is time- and cost-effective, offering valuable learning experiences.
- Significant disparities in Wilms' tumour (WT) outcomes between high- and low-income countries underscore the need for improved access to services and multidisciplinary care.
- This study demonstrates a novel methodology for global research in pediatric oncology, advocating for institutional development in underserved regions.
Background:
Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT).
Methods:
This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death).
Results:
There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X2 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X2 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks.
Conclusions:
This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.
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