Browsing by Author "Hesseling, P.B."
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Item Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa(Nature Reviews Clinical Oncology, 2013-07) Israëls, T.; Kambugu, J.; Kouya, F.; El-Mallawany, N.K.; Hesseling, P.B.; Kaspers, G.J.L.; Eden, T.; Renner, L.; Molyneux, E.M.Over 80% of children with cancer live in low and middle-income countries where survival rates are much lower than high-income countries. Challenges to successful treatment of paediatric cancers in these countries include late presentation, malnutrition, failure to complete treatment and less-intense supportive care leading to increased treatment-related mortality and the need to reduce the intensity of treatment. Clinical trials can contribute to improved care and survival by providing objective information on the number of patients treated, accuracy of diagnosis, causes of treatment failure and the efficacy of specific interventions. Clinical trials can also help to build capacity (salary support and training), improve facilities (equipment) and fund treatment or essential associated costs (social support, nutritional support and follow-up care). In this article, we discuss our experience with clinical trials in Malawi and sub-Saharan Africa with emphasis on the treatment of children with Wilms tumour. © 2013 Macmillan Publishers Limited.Item Treating burkitt's lymphoma in Malawi, Cameroon, and Ghana.(2008-06) Hesseling, P.B.; Molyneux, E.; Tchintseme, F.; Welbeck, J.; McCormick, P.; Pritchard-Jones, K.; Wagner, H.P.The Special Report: International published in the April issue of The Lancet Oncology, raised valid concerns about the issue of treating childhood Burkitt's lymphoma in Kenya and Uganda.1 These same concerns were voiced by delegates from 13 African countries at the first African Continental Conference of the International Society of Paediatric Oncology (SIOP) in Stellenbosch, South Africa, in 1994. At the end of this conference, a decision was made to develop effective and affordable treatment for African children with endemic Burkitt's lymphoma. At that time, over 90% event-free survival was being achieved in French children with sporadic Burkitt's lymphoma by use of short, but intensive, multidrug chemotherapeutic regimens adapted to initial tumour burden and response to chemotherapy.2 However, these Lymphome Malins de Burkitt (LMB) regimens included high doses of cyclophosphamide, doxorubicin, and methotrexate and needed a high level of supportive care. Thus, these regimens were clearly not feasible for the treatment of malnourished children with comorbidities in Africa. Hence, SIOP supported a study in Malawi, in which an overall 52% 1-year event-free survival was achieved for patients with St Jude stage I, II, or III endemic Burkitt's lymphoma, by use of a simplified LMB-like protocol. However, the cost of this treatment was too high and there were many toxic effects.3