1 of 16

��Evaluation of potential risk for developing treatment-associated late effects among childhood cancer survivors in Northern Tanzania��These slides were generously donated to the SOPHEA project by��

Goodluck Nchasi, Gaudence Ajuaye, David Noyd, Hannah Spiegl, Erica Sanga, Heronima Joas, Kristin Schroeder

October 2023

2 of 16

�� https://creativecommons.org/share-your-work/cclicenses/�

You may use these slides under the following Creative Commons license:

3 of 16

Background

According to WHO, each year, an estimated 400 000 children and adolescents of 0-19 years old develop cancer.

Global advancement in pediatric cancer treatment has significantly increased survival rates for children with cancer.

Childhood cancer survivors (CCS) now represent a growing population at risk of potentially debilitating late effects of their treatment.

4 of 16

Background

In literature from large survivor cohort studies in High Income Countries, three in every four survivors experience late effects of cancer treatment, of which 37% are life-threatening.

In Tanzania, survival rates for children diagnosed with cancer has increased from 20% to 50%, but there is a lack of data on the magnitude of treatment late effects among survivors.

5 of 16

Objectives

To evaluate potential risk for developing late effects of treatment among childhood cancer survivors based on standard treatment protocols at Bugando Medical Centre (BMC).
Compare the relative risk of late effects among childhood cancer survivors at BMC as compared to the published childhood cancer cohort.

6 of 16

Methods

Data from previously established survivor cohort with all 190 patients who completed their treatment at BMC from 2016 to 2022 was retrospectively reviewed.

STUDY AREA - Bugando Medical Centre (BMC)

STUDY DESIGN - This is a retrospective cohort study to assess the potential risk of late effects based on

treatment received for patients at the pediatric oncology unit of Bugando Medical

Center who completed therapy (from 2016 to 2022)

STUDY POPULATION

The study included all children who completed cancer treatment at the pediatric

oncology unit of Bugando Medical Center (from 2016 to 2022) that are included in

the previously established BMC pediatric cancer database.

SAMPLE SIZE

The survey included all 190 childhood cancer survivors who completed therapy at the

pediatric oncology unit of Bugando Medical Center

SAMPLING METHOD

All pediatric patients who completed cancer treatment and have available treatment

details in the previously established database at the pediatric oncology unit of

Bugando Medical Center will be included in the analysis

DATA COLLECTION

Pediatric cancer database was reviewed to extract details of primary disease, treatment

received and cumulative doses of individual chemotherapies or radiation. Known

exposures were reported as dichotomous (Yes/No) for surgery, diagnostic biopsy,

radiation, chemotherapy, with subcategories for exposure to known high risk late-effect

therapy (i.e., doxorubicin, cisplatin, cranial radiation) as indicated in the Children’s

Oncology Group Long-Term Follow-Up Guidelines.

7 of 16

Methods

York JM. Generously supported by With special appreciation to Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers [Internet]. 2018. Available from: www.survivorshipguidelines.org

8 of 16

Methods

9 of 16

Methods

In addition, the Childhood Cancer Survivor Study (CCSS) late heart failure risk calculator was utilized for risk stratification for cardiovascular disease

This validated tool incorporates variables (sex, age at cancer diagnosis, and anthracycline and chest radiotherapy doses).

CCSS Cardiovascular Risk Calculator | St. Jude CCSS [Internet]. [cited 2023 Jun 7]. Available from: https://ccss.stjude.org/tools-documents/calculators-other-tools/ccss-cardiovascular-risk-calculator.html

10 of 16

Results - Demographics

A total of 190 childhood cancer survivors were initially identified, with 17 excluded due to missing treatment information.
Among remaining 173 patients the mean age was 7 years old and 47% were female (n=82)

11 of 16

Results – Treatment Exposure & Late effect

12 of 16

Results - Risk Stratification

13 of 16

Conclusion

Childhood cancer survivors at BMC have a higher risk of late effects as compared to published survivor cohorts in high-income countries.

There is a need to develop and improve long-term follow-up care for survivors by enhancing patient and provider education to promote early detection of late effects.

14 of 16

Action/ Reflection Points

Look into the environmental factors that might be the causative or carcinogenic agents that increase the incidence rates of child health cancer in the areas of Northern Tanzania.

Can you think of environmental factors in your region / country that can affect chronic diseases?

15 of 16

Questions or comments ?

Thank you for your attention !

16 of 16

Acknowledgement

BMC Pediatric Oncology Team

TAMSA Research Scholars Program

BMC-Duke Collaboration