TY - JOUR
T1 - Temporal trends in childhood cancer survival in Egypt, 2007 to 2017
T2 - A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt
AU - Soliman, Ranin M.
AU - Elhaddad, Alaa
AU - Oke, Jason
AU - Eweida, Wael
AU - Sidhom, Iman
AU - Ahmed, Sonia
AU - Abdelrahman, Hany
AU - Moussa, Emad
AU - Fawzy, Mohamed
AU - Zamzam, Manal
AU - Zekri, Wael
AU - Hafez, Hanafy
AU - Sedky, Mohamed
AU - Abdalla, Amr
AU - Hammad, Mahmoud
AU - Elzomor, Hossam
AU - Ahmed, Sahar
AU - Awad, Madeha
AU - Abdelhameed, Sayed
AU - Mohsen, Enas
AU - Shalaby, Lobna
AU - Fouad, Heba
AU - Tarek, Nourhan
AU - Abouelnaga, Sherif
AU - Heneghan, Carl
N1 - Funding Information:
RS was supported by Egypt Cancer Network (ECN) and Kellogg College Travel Grant at the University of Oxford to communicate preliminary study results at EBM Live conference 2019. CH received expenses and fees for his media work, expenses from the WHO and holds grant funding from the NIHR Oxford BRC and the NIHR School of Primary Care Research Evidence Synthesis Working Group (Project 390). CH is Director of the CEBM at the University of Oxford, Editor in Chief of BMJ Evidence‐Based Medicine and an NIHR Senior Investigator. We declare no other competing interests. All remaining authors have declared no conflicts of interest.
Funding Information:
We gratefully thank the pediatric oncology team at CCHE for their contribution to care delivery and documentation of patients' data in the electronic medical records. We also thank the clinical research department at CCHE for data collection and data quality validation on routine basis, especially Dr Mohamed Kamal and Dr Nada Elkhateeb for retrieving data for the study. RS was supported by Egypt Cancer Network (ECN) and Kellogg College Travel Grant to communicate preliminary results at EBM Live conference 2019. CH is supported by The Evidence Synthesis Working Group and is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR) (Project Number 390) and NIHR Oxford BRC. The views expressed are those of the author(s) and not necessarily those of the NIHR, the NHS or the Department of Health.
Publisher Copyright:
© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P <.001) and by calendar periods from 69.6% to 74.2% (P <.0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P <.001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
AB - Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P <.001) and by calendar periods from 69.6% to 74.2% (P <.0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P <.001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
KW - childhood cancer
KW - developing countries
KW - global oncology
KW - real-world evidence
KW - survival trends
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U2 - 10.1002/ijc.33321
DO - 10.1002/ijc.33321
M3 - Article
C2 - 32997796
AN - SCOPUS:85092581504
SN - 0020-7136
VL - 148
SP - 1562
EP - 1574
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 7
ER -