Wilms tumor survival in Kenya

Jason Axt, Fatmah Abdallah, Meridith Axt, Jessie Githanga, Erik Hansen, Joel Lessan, Ming Li, Joyce Musimbi, Michael Mwachiro, Mark Newton, James Ndung'U, Festis Njuguna, Ancent Nzioka, Oliver Oruko, Kirtika Patel, Robert Tenge, Flora Ukoli, Russel White, James A. O'Neill, Harold N. Lovvorn

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Purpose Survival from Wilms Tumor (WT) exceeds 90% at 5 years in developed nations, whereas at last report, 2-year event-free survival (EFS) in Kenya reached only 35%. To clarify factors linked to these poor outcomes in Kenya, we established a comprehensive web-based WT registry, comprised of patients from the four primary hospitals treating childhood cancers. Materials and methods WT patients diagnosed between January 2008 and January 2012 were identified. Files were abstracted for demographic characteristics, treatment regimens, and enrollment in the Kenyan National Hospital Insurance Fund (NHIF). Children under 15 years of age having both a primary kidney tumor on imaging and concordant histology consistent with WT were included. Results Two-year event-free survival (EFS) was 52.7% for all patients (n = 133), although loss to follow up (LTFU) was 50%. For the 33 patients who completed all scheduled standard therapy, 2-year EFS was 94%. Patients enrolled in NHIF tended to complete more standard therapy and had a lower hazard of death (Cox 0.192, p < 0.001). Conclusion Survival of Kenyan WT patients has increased slightly since last report. Notably, WT patients completing all phases of standard therapy experienced 2-year survival approaching the benchmarks of developed nations. Efforts in Kenya should be made to enhance compliance with WT treatment through NHIF enrollment.

Original languageEnglish (US)
Pages (from-to)1254-1262
Number of pages9
JournalJournal of Pediatric Surgery
Volume48
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Global health
  • Kenya
  • Pediatric cancer
  • Race disparity
  • Wilms tumor

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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