Treating Nephroblastoma in Rwanda: Using International Society of Pediatric Oncology Guidelines in a Novel Oncologic Care Model.

Autor:	Shyirambere C; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Xu MJ; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Elmore SN; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Fadelu T; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., May L; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Tapela N; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Umuhizi DG; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Uwizeye FR; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Driscoll C; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Muhayimana C; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Hategekimana V; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Rubagumya F; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Nzayisenga I; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Shulman LN; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Mpunga T; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY., Lehmann LE; , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY.
Jazyk:	angličtina
Zdroj:	Journal of global oncology [J Glob Oncol] 2016 Jan 27; Vol. 2 (3), pp. 105-113. Date of Electronic Publication: 2016 Jan 27 (Print Publication: 2016).
DOI:	10.1200/JGO.2015.000067
Abstrakt:	Purpose: Success in treating nephroblastoma in high-income countries has been transferred to some resource-constrained settings; multicenter studies report disease-free survival of greater than 70%. However, few reports present care models with rural-based components, care tasks shifted to internists and pediatricians, and data collection structured for monitoring and evaluation. Here, we report clinical outcomes and protocol compliance for patients with nephroblastoma evaluated at Butaro Cancer Center of Excellence in Rwanda. Patients and Methods: This retrospective study reports the care of 53 patients evaluated between July 1, 2012, and June 30, 2014. Patients receiving less than half of their chemotherapy at Butaro Cancer Center of Excellence were excluded. Results: Of the 53 patients included, 9.4% had stage I, 13.2% had stage II, 24.5% had stage III, 26.4% had stage IV, and 5.7% had stage V disease; the remaining 20.8% had unknown stage disease from inadequate work-up or unavailable surgical report. The incidence of neutropenia increased with treatment progression, and the greatest proportion of delays occurred during the surgical referral phase. At the end of the study period, 32.1% of patients (n = 17) remained alive after treatment; 24.5% (n = 13) remained alive while continuing treatment, including one patient with recurrent disease; 30.2% (n = 16) died; and 13.2% (n = 7) were lost to follow-up. Conclusion: Our findings confirm that nephroblastoma can be effectively treated in resource-constrained settings. Using an approach in which chemotherapy is delivered at a rural-based center by nononcologists and data are used for routine evaluation, care can be delivered in safe, novel ways. Protocol modifications to mitigate chemotherapy toxicities and strong communication between the multidisciplinary team members will likely minimize delays and further improve outcomes in similar settings. Competing Interests: Authors' disclosures of potential conflicts of interest and contributions are found at the end of this article. The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or jco.ascopubs.org/site/ifc. Cyprien ShyirambereNo relationship to discloseMary Jue XuEmployment: Merck Research Funding: MerckShekinah Nefreteri ElmoreNo relationship to discloseTemidayo FadeluNo relationship to discloseLeana MayConsulting or Advisory Role: Best DoctorsNeo TapelaNo relationship to discloseDenis Gilbert UmuhiziNo relationship to discloseFrank Regis UwizeyeNo relationship to discloseCaitlin DriscollStock or Other Ownership: Gilead Sciences, Exact SciencesClemence MuhayimanaNo relationship to discloseVedaste HategekimanaNo relationship to discloseFidel RubagumyaNo relationship to discloseIgnace NzayisengaNo relationship to discloseLawrence N. ShulmanNo relationship to discloseTharcisse MpungaNo relationship to discloseLeslie E. LehmannNo relationship to disclose
Databáze:	MEDLINE
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