Laila Hessissen

Introduction: Colorectal cancer (CRC) is increasing in Africa, yet reports in children and adolescents are limited. We describe the epidemiology, management, and survival outcomes of CRC in African children. Methods: Retrospective data of children under 19 years diagnosed with CRC between 2000 and 2023 were collected from 14 African countries. Patient and tumor characteristics and treatment data were described and survival outcomes analyzed. GLOBOCAN data were used to evaluate age‐related geographical distribution of CRC. Results: Hundred‐and‐eight patients, 57.4% males, were diagnosed with a mean age of 14.9 (range 5–18) years. The mean symptom‐onset‐to‐diagnosis duration was 90 days (range 2–1200). Most common symptoms were abdominal discomfort (70.6%) and change in bowel habits (57.8%). The commonest primary site was the ascending colon (30.6%) with a mean tumor size of 64.3 mm (range 30–150 mm) and 37% presenting in stage III and 36.1% in stage IV. Most (83.3%) tumors were confirmed on histology, of which 78.7% were adenocarcinoma. Carcinoembryonic antigen was performed in 38.9% of patients. Complete resection was achieved in 55.6% of cases, while 18.5% received radiotherapy. Folinic acid, Fluorouracil, Oxaliplatin (FOLFOX) was the first line chemotherapy in 48.1% of patients. A third of patients were lost to follow‐up while 25.6% experienced disease progression. The 2‐year and 5‐year overall survival rates were 40.0% and 16.9%, respectively. Disease stage ( p = 0.07) and degree of resection ( p = 0.02) predicted outcomes. Conclusion: Pediatric CRC is characterized by delayed diagnosis and advanced stage presentation, contributing to a significantly lower overall survival compared to adults. Focused research and multidisciplinary management are needed to understand pediatric CRC and improve outcomes.

PURPOSE: Video teleconferencing in neuro-oncology is feasible and sustainable. The well-established, 20-year long monthly teleconference between King Hussein Cancer Center (KHCC), Jordan, and SickKids, Canada, is an example. Since 2018, several regional centers joined these meetings to discuss their patients' management plans. We aim to evaluate this experience. METHODS: We reviewed the minutes of 56 meetings (2018-2023). Preconference local treatment plans were compared with postconference recommendations. We documented the implementation of recommendations and the impact perceived by the treating oncologists. RESULTS: Two hundred fifty-one patients were discussed: 137 from Jordan and 114 from eight other countries. Four of the 14 participating oncologists had formal pediatric neuro-oncology training. Of the 227 patients (90%), where the local multidisciplinary team had suggested a preconference plan, the teleconference recommendations concurred with the proposed plan in 50% of cases, agreed on it and proposed an alternative option in 18%, and disagreed in 32%. The difference in recommendations mostly affected the proposed treatment modality. In 64% of discordant plans and 50% of alternative plans, the treating team applied the recommendations. The main challenges in applying the recommendations were attributed to patient-related factors (51%), local team consensus on a different plan (26%), or logistic difficulties (23%). The high patient load, longer involvement in teleconferencing, formal neuro-oncology training, and well-established multidisciplinary team helped the KHCC team formulate more concordant plans. CONCLUSION: This experience illustrates the potential benefit for physicians to get an expert opinion on challenging cases. The participating oncologists valued the shared educational experience, especially those related to molecular testing and treatment implications. Joining such regional teleconferences is of particular importance to centers with small patient volume or those lacking a pediatric neuro-oncologist.

Childhood cancer in Africa faces significant challenges due to workforce shortages and limited training opportunities. The French African Group for Pediatric Oncology (GFAOP) established the African School of Pediatric Oncology and introduced a pediatric oncology teaching called the “Diplome Universitaire de Cancérologie Pédiatrique” (DUCP) training program. This report evaluates the contributions of the DUCP program to pediatric oncology in Africa and discusses the sustainability of the program. The DUCP program trained six cohorts of healthcare professionals from French-speaking African countries since 2014. An evaluation was done on the participant demographics and regional contributions. Data were collected from trainee records and DUCP records. The DUCP program was evaluated based on the domains developed by the Education Program Assessment Tool (EPAT). Over the 10-year period, the DUCP program trained 107 healthcare professionals from 20 Francophone countries of which 99% were retained in Africa. Of the 83 graduates, 55 (66%) actively practice in pediatric oncology. Of the 18 francophone countries, 17 countries increased the number of pediatric oncologists and 16 improved the ratio of pediatric oncologists to children under 15 years. Nine new pediatric oncology services were established by the graduates thus far. Despite challenges, such as the COVID−19 pandemic, the program remains sustainable because of continued financial support, collaborations with the international pediatric oncology community, and adapting the program content to participant and local setting needs. Retention of graduates in childhood cancer services remains a challenge that necessitates governmental involvement. The DUCP program is impactful and sustainable and improves access for children to cancer services in Africa. By fostering continued collaboration with governments, addressing the needs of an increasing African population, and expanding support for similar initiatives, the program’s longevity and positive impact can be further ensured.

Limited survival data for the six Global Initiative for Childhood Cancer (GICC) priority cancers are available in Africa. Management of pediatric malignancies in Africa is challenging due to lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment. Reporting of outcome data is problematic due to the lack of registries. With the aim of evaluating the feasibility of baseline outcomes for the six index cancers, we present a descriptive analysis of respective survival rates in Africa. The survival rates were between 18% (lower middle-income countries) to 82.3% (upper middle-income countries) for acute lymphoblastic leukemia, between 26.9% (low-income countries) to 77.9% (upper middle-income countries) for nephroblastoma, between 23% (low-income countries) to 100% (upper middle-income countries), for retinoblastoma, 45% (low-income countries) to 95% (upper middle-income countries) for Hodgkin lymphoma and 28% (low-income countries) to 76% (upper middle-income countries) for Burkitt lymphoma. Solutions to improve survival rates and reported outcomes include establishing and funding sustainable registries, training and to actively include all countries in consortia from different African regions.

Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn’t exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for.