Background and Aims

Abandonment is one of the dominant causes of treatment failure in LMIC’s. This analysis was performed to assess the magnitude and identify the reasons for abandonment.

Methods

Children diagnosed between July 2020 and February 2022 were followed for 6 months to record abandonment of therapy. Reasons for abandonment were recorded by a physical or telephonic structured questionnaire.

Results

Abandonment was observed in 122/763 (16.5 %) patients with upfront refusal in 72(59%) and 50 (41%) abandoning after 4 (IQR 2-8) weeks of therapy. Mean age: 4.5 years (0.3-12 years), 71 males and 51 females. Diagnosis: ALL: 33%; AML: 12%; Neuroblastoma: 11%; Retinoblastoma: 10% and other solid tumours (17%) with 22/59 solid tumours having metastatic disease and 48/122(39.3%) a poor prognosis.

Majority(79%) lived >100km from our center, 11% residing within 50 km. Twenty percent families were illiterate, 42% fathers being unskilled workers ; unemployed( 3.3%) professionals (5.7%) & self employed( 5%). Average monthly income was USD 200, (GDP per capita USD 160). Most families were nuclear (85%), 2/3rd belonging to rural areas. Nearly 70% patients were eligible for financial aid from the government.

Reasons for abandonment were multifactorial: finances & distance from centre being predominant (42% & 19%); belief of no cure 12%; fear of chemotherapy 13%; family problems 12%; poor prognosis 10%; inability to get leave from work 6.6%. Thirteen (10.6%) took alternative medicine. On patient tracking, 14(11%) are on treatment elsewhere and 13 (10.6%) returned for therapy after 6.5 (2-12) weeks, reducing abandonment to 12.7%.

Conclusions

Abandonment rate was 16.5%, despite fiscal aid in approximately 70%. Tracking helped identify patients resuming therapy (27/122[22%]). Ensuring holistic support and establishing a patient tracking system will help reduce abandonment & improve survival. Information regarding curability of disease needs widespread dissemination. Additional cancer centers, shared care & telemedicine are the need of the hour for comprehensive care.

Background and Aims

The childhood cancer burden has impacted Low-Middle income countries (LMICs). Regional networks aim at building capacity while supporting health services. CCHE57357 developed a national pediatric cancer program by designing integrated frameworks of care and building human resource capacity through partnerships to provide quality healthcare. Our aim is to ensure that every caregiver involved in pediatric cancer care, from diagnosis to treatment, has the training they need to heal children suffering from cancer.

Methods

In 2012 we initiated a collaboration with African countries in response of a national outreach initiative to reach out to all our neighboring nations, to share and disseminate the knowledge and resources of CCHE, thus bridging the gaps in Children's care. We collaborated and partnered with major hospitals and academic institutions to train local and regional medical professionals to recognize cancers early, diagnose them accurately, and treat them effectively through structured training programs developed according to International standards and tailored to suit the continental needs.

Results

Throughout our journey, we have succeeded to train physicians from (Ethiopia, Kenya, Kuwait, and Sudan) through our fellowship training program in collaboration with DF/BC that engages world-renowned hematologists and oncologists to provide on-site and online training to specialists in pediatric oncology/hematology. We have trained more than 600 nurses from different African countries in intensive pediatric hematology/oncology nursing training pursuant. We connected more than 100 clinical pharmacists at our partner institutions with off-site training programs designed to build knowledge and capability in chemotherapy preparation, and pharmacotherapy. We also assisted our partners in developing on-site oncology pharmacies. We have partnered with the International agency of Nuclear energy to train tens of African and Arabic radiotherapists and Radiotherapy physicists to be able to function and treat children at their premises.

Conclusions

Structured training and partnerships help creating healthcare change agents who can lead their teams and provide better healthcare to cancer children.

Background and Aims

In the world, the incidence of COVID-19 cases in pediatrics patients is lower than in adults and the clinical picture is less aggressive. At the moment, there is little Latin American literature on the behavior of COVID-19 in children with oncological pathology. The incidence of childhood cancer in Argentina represents 132 cases per million (1350 cases per year). It is important to know the impact and evolution of COVID-19 in order to generate adequate health policies.Objectives: To characterize the epidemiology, clinical course, morbidity and mortality of oncopediatric cases with COVID-19.

Methods

The cases registered in the ROHA with a diagnosis of SARS-Cov2 by PCR technique between 12/4/2020 and 05/03/2022 were included. The variables analyzed were: sex, age at diagnosis of COVID-19, clinic upon admission, severity of symptoms, type of tumor according to the International Classification of Childhood Cancer - Third Edition ICCC-3, requirement for critical care, specific treatment for COVID, status and cause of death.

Results

888 oncopediatric COVID-19 cases were registered, (female=484), 437(49.2%) Leukemias, 120(13.5%) Central Nervous System (T-CNS), 89(10.0%) Lymphomas, 66(7.4%) Bone Tumors, 51(5.7%) Soft Tissue Tumors, 37(4.2%) Neuroblastomas, 25(2.8%) Retinoblastomas, 23(2.6%) Kidney Tumors, 14(1.6%) Liver Tumors, 14(1.6%) Germ cell tumors and other tumors 12(1.4%). 57.2% were symptomatic (n=508). Among these, 75% were febrile, 37% had neutropenia (n=210). 17.1% (n=152) were diagnosed within a month of oncological diagnosis, 20 patients had critical symptoms of severity, 22 patients received specific treatment. Deaths were reported in 112 (58 leukemia/lymphoma, 14 T-CNS) 105 due to progression, sepsis, comorbidity or therapeutic complications. Seven patients (0.8%) diagnosed with leukemia/lymphoma died from COVID-19, 6 of them older than 10 years of age.

Conclusions

From the interpretation of the ROHA data we can conclude that in pediatric oncologic patients, contrary to what was initially expected, morbidity and mortality was not increased.

Background and Aims

Children with acute myeloid leukemia (AML) are at a particularly high risk for infectious complicatons related to the highly intensive chemotherapy. The aim of the study is to: assess the risk factors, infectious complications and assess outcome of febrile episodes in children with AML at the Pediatric Oncology Department, National Cancer Institute, Cairo University from January 2016 to December 2019.

Methods

Infectious complications were evaluated retrospectively in 621 febrile episodes in101 Patients :were divided into survivors and non-survivors according to outcome at end of each episode. Each febrile episode was interpreted in correlation with infectious complications .

Results

Mortality from gram negative bacteremia was 29.9%, in febrile episodes with multidrug resistant gram negative bacteremia: Mortality was 39.2 % .In febrile episodes with multidrug resistant gram negative bacteremia and septic shock. Mortality was 71.8 % (p value <0.001). Mortality was high in early chemotherapy phase (intensive timing). Infection related mortality was 39%. In our institute there is epidemiological shift towards gram negative organisms.In clinically documented febrile episodes: Mortality was 13.2 % (p value <0.001). Mortality rate was 15.3% for patients who presented with pneumonia, as compared to 6 % who hadn’t. (P value = 0.001) .It was 25.7% for patients who had typhilitis/colitis, as compared to 9% who hadn’t. (P value <0.001; statistically significant). However, it was 11.7% for patients who had soft tissue infection, as compared to 9% who hadn’t. In clinically documented febrile episodes with multidrug resistant gram-negative bacteremia: Mortality was 42.9% (p value =0.122). Mortality from febrile episodes with ICU admission was 58.5 %. (P value <0.001).

Conclusions

Sepsis and septic shock are major causes of mortality . Improved management of sepsis during neutropenia may reduce the mortality of pediatric Acute myeloid leukemia. It is Important to trace the predictors that may impact the outcome of febrile episode.

Background and Aims

The management of pediatric oncology patients with an indwelling central venous catheter (CVC) who present with fever without severe neutropenia (ANC >500/mcL) varies widely within and across institutions due to lack of consensus guidelines. At our institution, a retrospective review of oncology patients with a CVC presenting to the Pediatric Ambulatory Care Center (PACC) with non-neutropenic fever (NNF) revealed that 97% received at least one dose of parenteral antibiotics despite low rates of bacteremia (2.3%). Given these results, a prospective quality improvement intervention was initiated with the goal of decreasing empiric antibiotic administration in pediatric oncology patients with a CVC presenting with NNF who are low-risk for bacteremia.

Methods

An algorithm for assessing patients at low risk of bacteremia was developed through consultation with local experts. All patients undergoing treatment for malignancy presenting to the PACC at Memorial Sloan Kettering Cancer Center with a CVC and NNF were assessed for eligibility. In patients meeting low-risk criteria, blood cultures were sent, and discharge home was recommended without administering empiric antibiotics. Patients were followed for 72 hours from initial visit (considered one episode) and all events within this time period were noted. Visits were reviewed weekly and positive blood cultures monitored daily.

Results

Between 4/12/2021 – 3/13/2022, 216 episodes met inclusion criteria, of which 8.8% (n=19) received antibiotics at initial visit. Analysis of outcomes in patients not receiving antibiotics (n=197) revealed a 2.5% rate of bacteremia within the episode, while an additional 2% were admitted for infectious concerns without a positive blood culture. There were no infection-related ICU admissions or deaths in any patient in whom antibiotics was withheld during this period.

Conclusions

We have shown that withholding antibiotics in a select population of pediatric oncology patients with a CVC who present with NNF is safe and complements ongoing institutional efforts to improve antimicrobial stewardship.

Background and Aims

Epidemiology of Clostridioides difficile infection (CDI) in pediatric patients with cancer and hematopoietic stem cell transplant recipients is uncertain. Additionally, a definition of severe CDI applicable to these patients is currently not available.

Primary objective was to describe the prevalence of CDI outcomes among pediatric patients receiving cancer treatments. Secondary objectives were to describe clinical features of CDI, propose a definition of severe CDI and to determine risk factors for CDI clinical outcomes.

Methods

We conducted a multi-center retrospective cohort study. Inclusion criteria were pediatric patients (1-18 years of age) receiving cancer treatments with CDI. Primary outcomes were clinical cure, recurrence, global cure and repeated new CDI episodes. Severe CDI definition was achieved by reviewing distribution of potential indicators of severe CDI and identifying factors by consensus. Univariable and multivariable regression was conducted to evaluate risk factors for CDI outcomes.

Results

There were 627 eligible patients who experienced 721 CDI episodes. Prevalence of clinical cure was 82.9%, recurrence was 9.6%, global cure was 75.0% and repeated new CDI episode was 12.8%. The most common initial antibiotic treatments were oral metronidazole (388, 53.8%), intravenous metronidazole (162, 22.5%) and oral vancomycin (151, 20.9%). The proposed definition of severe CDI was the presence of colitis, pneumatosis intestinalis, pseudomembranous colitis, ileus or surgery for CDI, occurring in 70 (9.7%) episodes. In multiple regression, oral metronidazole was significantly associated with higher odds (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.0-2.7) and oral vancomycin was significantly associated with lower odds (OR 0.4, 95% CI 0.2-0.8) of repeated new episodes.

Conclusions

The prevalence of clinical cure was 82.9% and recurrence was 9.6% in pediatric patients receiving cancer treatments. Severe CDI, as per our proposed definition, occurred in 9.7% episodes. Initial oral vancomycin was significantly associated with a reduction in repeated new CDI episodes.