childhood cancer

Background: The number of childhood cancer survivors (CCSs) is increasing due to improved survival. Most suffer at least one treatment-related late effect, even decades after treatment, thus lifelong long-term follow-up (LTFU) care is a necessity. Currently no standardized LTFU programme for CCSs exists in South Africa. Study purpose: This study investigated current LTFU care of CCSs in South Africa. Methods: A survey was conducted amongst 31 South African paediatric oncologists using the SurveyMonkeyTM online tool. Information obtained included: training/experience, LTFU practices, late effects knowledge and opinion regarding the importance of a standardized LTFU programme. Results: The response rate was 74% (23/31). Respondents had an average of 9 years’ experience. All (22/23; 96%) regarded LTFU as important. Only half (12/23; 52%) discussed late effects at diagnosis. Infertility and second malignancy risks were discussed by a third. Less than half (48%) used LTFU guidelines; the majority (9/11; 82%) adjusted them to the local context. Most survivors were followed by a paediatric oncologist (17/23; 74%). About half of respondents (47.8%) shared LTFU with colleagues in private practice (50%), secondary (66.7%) or primary care facilities (25%). Almost half of respondents (10/23; 43.5%) regarded their late effects knowledge and LTFU experience as good, 8/23 (34.8%) as adequate and 3/23 (13%) as inadequate. All agreed that a national LTFU programme would be very important (87%) or important (13%). Almost half of the respondents (48%) understood what a Survivorship Passport was. Conclusion: It is essential to develop a national standardized LTFU programme for CCSs in South Africa to ensure appropriate care for all survivors.

This study aimed to examine the disparities of childhood cancer survival among different racial and ethnic groups in Texas. The analysis was mediated by socioeconomic status (SES) and spatial accessibility to Children Oncology Group (COG) hospitals. The relationship between race-ethnicity and overall survival was measured using the Cox proportional hazards model with a robust variance estimator. The counterfactual model measures the total effect of race-ethnicity on survival through all mediating pathways while adjusting for baseline confounders (age, sex, and stage at diagnosis), which are then decomposed into natural direct and indirect effects. Considering all cancer site groups, African Americans showed a statistically significant higher hazard ratio in death (HR = 3.63; 95% CI = 1.87 - 6.62) compared with non-Hispanic White children. At the same time, the mortality hazard ratio among Hispanic children is not significant (HR = 1.23; 95% CI = 0.80 - 1.93) when compared with non-Hispanic White children. Analysis results also suggested that both mediators significantly contribute to racial-ethnic survival disparities for specific cancer site groups such as Leukemia for African American children. This study builds knowledge and understanding about underlying factors (mediators) responsible for the disparities in the outcomes among childhood cancer patients.