Browsing by Author "Molyneux, E."
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Item Are essential medicines available, reliable and affordable in low-middle income countries?(Journal of Cancer Policy, 2019-03) Eden, T.; Burns, E.; Freccero, P.; Renner, L.; Paintsil, V.; Dolendo, M.; Scanlan, T.; Khaing, A.A.; Pina, M.; Islam, A.; Chunda-Liyoka, C.; Kouya, F.; Molyneux, E.A critical challenge for reducing the cancer survival disparity between children living in low-middle income countries (LMICs) and those in high income countries (HICs) is the apparent lack of consistent supplies of reliable, good quality, effective and affordable essential medicines for curative, supportive and palliative care in LMICs. Using a semi-structured 17 point questionnaire we asked ten paediatricians in nine countries for their perceptions of availability, accessibility, affordability and quality of the drugs they needed to treat their patients with cancer. All the countries needed to procure and import some or all of the required essential medicines. Despite their countries signing up to the latest World Health Organisation Essential Medicines Listing there were inconsistent supplies of key medicines. This occurred sometimes due to inadequate global production of some drugs but more often to failure of adequate registration, procurement, importation and distribution. Costs played a significant role regarding prompt importation in some of the countries and cheaper biosimilar drugs were procured often without certification of quality production and provenance. Where families carried the whole financial burden of drug costs the doctors cited it as a major but not the only reason for treatment refusal or subsequent abandonment. Only a concerted effort by each country, the WHO, ethical pharmaceutical companies and all worldwide medical and nursing groups, with the help of parent support organisations across the world can overcome the failure of access to, affordability of and ensured quality of these off -patent, generic drugs. This applies not just to childhood cancer but all medicines for communicable and non-communicable diseases.Item The Collaborative Wilms Tumour Africa Project; Baseline evaluation of Wilms tumour treatment and outcome in eight institutes in sub-Saharan Africa(European Journal of Cancer, 2015-01) Paintsil, V.; David, H.; Kambugu, J.; Renner, L.; Kouya, F.; Eden, T.; Hesseling, P.; Molyneux, E.; Israels, T.Aim Reported survival of Wilms tumour in sub-Saharan Africa is below 50%. A published International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) consensus adapted treatment guideline is implemented as a multi-centre prospective clinical trial at eight centres in sub-Saharan Africa. A baseline evaluation has been done to help decide on priorities to improve outcome and to assess improvements over time. Methods A retrospective chart review was performed of patients admitted with Wilms tumour in the three years (2011-2013) preceding the collaborative trial. Patient outcome at the end of treatment was documented for all patients diagnosed in 2011 and 2012. Outcome was classified as (1) alive, no evidence of disease; (2) alive with disease; (3) died during treatment and (4) incomplete treatment. Details on treatment facilities, staff and estimated cost of treatment are documented. Results Every year 114-130 patients are diagnosed. The mean survival at end of treatment is 39% (69/176) ranging from 11% to 61%. Incomplete treatment is the most common cause of treatment failure with 31% (54/176), ranging from 14% to 48% between centres. Twenty-six percent (46/176) of patients died during treatment, ranging from 13% to 37%. Estimated cost of treatment for parents ranged from 100 US$ to 1100 US$ and was considered an important cause of failure to complete treatment. Conclusion Overall two year survival is estimated at 25%. Prevention of incomplete treatment is possible and will positively affect outcome. Sharing similar local challenges in this regional collaborative project helps to identify and implement feasible, sustainable and successful strategies. © 2014 Elsevier Ltd. All rights reserved.Item Haematological Cancers in African Children: Progress and Challenges(British Journal of Haematology, 2017-06) Molyneux, E.; Scanlan, T.; Chagaluka, G.; Renner, L.Cancer is increasingly important in low and middle-income settings where infectious diseases are declining. Childhood cancers treated in well-resourced centres have excellent outcomes with more than 80% survival. This success is not reflected in low-income settings where challenges involve every step on the care pathway. Access to diagnosis, delayed presentation, advanced disease, co-morbidities and underlying malnutrition make treatment difficult. Treatments are costly for impoverished families. Yet, the common haematological malignancies (Burkitt lymphoma, Hodgkin lymphoma, non Hodgkin lymphoma) are relatively easy to diagnose and, when managed with simple chemotherapy protocols, give limited but good results. As funding becomes available for cancer research we must ensure that the care and cure of these children is top of the agenda. There is already evidence of improved outcomes in middle-income countries. For others there is a long journey ahead.Item Improved outcome at end of treatment in the collaborative Wilms tumour Africa project(John Wiley and Sons Inc., 2018-01) Israels, T.; Paintsil, V.; Nyirenda, D.; Kouya, F.; Mbah Afungchwi, G.; Hesseling, P.; Tump, C.; Kaspers, G.; Burns, L.; Singh Arora, R.; Chagaluka, G.; Nana, P.; Renner, L.; Molyneux, E.Background: The Collaborative Wilms Tumour (WT) Africa Project has implemented an adapted WT treatment guideline in sub-Saharan Africa as a multi-centre prospective clinical trial. A retrospective, baseline evaluation of end-of-treatment outcome was performed for a 2-year period prior to the introduction of this guideline. The collaborative project aims to reduce both treatment abandonment and death during treatment to less than 10% for improving survival. Procedure: All participating centres obtained local Institutional Research Board (IRB) approval and implemented the adapted WT treatment guideline. End-of-treatment outcome was documented for 2 years. It was divided into alive without evidence of disease, treatment abandonment, death during treatment and persistent disease. The outcome of children enroled in the first 2 years of the prospective clinical trial has been compared to the outcome before the start of the project. Results: One hundred twenty-two patients were included in the baseline evaluation (2011–2012) and 133 in the first 2 years of the collaborative clinical trial (2014–2015). The percentage of patients alive without evidence of disease at the end of treatment increased from 52% (63/122) to 68% (90/133; P = 0.01). Treatment abandonment decreased from 23% (28/122) to 13% (17/133; P = 0.03). Death during treatment decreased from 21% (26/122) to 13% (17/133; P = 0.07). Conclusion: This collaboration, using relatively simple and low-cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment. © 2018 Wiley Periodicals, Inc.Item Improvement of overall survival in the Collaborative Wilms Tumour Africa Project(Pediatric Blood & Cancer, 2020-05-11) Renner, L.; Chagaluka, G.; Paintsil, V.; Weijers, J.; Chitsike, I.; Borgstein, E.; Kamiza, S.; Afungchwi, G.M.; Kouya, F.; Hesseling, P.; Molyneux, E.; Israels, T.The Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub-Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event-free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation.Item SIOP PODC: Recommendations for supportive care of children with cancer in a low-income setting(Pediatric Blood and Cancer, 2013-06) Israels, T.; Renner, L.; Hendricks, M.; Hesseling, P.; Howard, S.; Molyneux, E.These supportive care recommendations were prepared to guide doctors who practice in areas with significantly limited resources but who have sufficient infrastructure and training to treat children with cancer with curative intent. The success of any cancer treatment regimen depends largely on the availability and quality of supportive care and this also determines the intensity of treatment that can be delivered. We present practical recommendations on how to prevent infections, general nursing care, management of febrile neutropenia, nutritional assessment and support, treatment of co-infections and the social support to help prevent failure to complete treatment in resource poor settings. © 2013 Wiley Periodicals, Inc.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