Background

Wilms tumour is a relatively common and treatable kidney tumour, with survival rates of around 85% in high income countries. Before the start of the project, estimated average survival of Wilms tumour patients was 25% in the participating centres. (1) Treatment is multi-disciplinary and includes the involvement of pediatricians, surgeons, nurses, radiologists and pathologists to name a few. A multi-disciplinary group of African clinicians from different countries and international experts produced a consensus treatment guideline adapted to local circumstances. This treatment guideline emphasizes social support to enable parents to complete treatment and provision of adequate supportive care. The guideline is now being used to treat children with Wilms tumour across several African centers, and the outcomes are monitored closely in order to understand the effectiveness of this treatment. 2)

 

Challenges
  • Families abandon treatment due to lack of social support

  • Limited access to diagnosis and treatment

  • Historical lack of a consensus treatment guideline

  • Little support for patients for drugs, transport and food

  • Inaccurate and delayed diagnosis

  • Little opportunity for collaboration and knowledge exchange

Facts & figures
  • 8 centres across 5 countries involved in the collaboration: Malawi, Cameroon (3 centres), Ghana (2 centres), Kenya, Zimbabwe

  • 85% survival rate of Wilms tumour patients in high income countries

  • 50% survival rate of Wilms tumour in the collaboration

  • Start Date of the project: March 2014

  • Program Mentor: Dr Trijn Israels, Princess Máxima Center, The Netherlands

  • Local Program Leaders: Dr George Chagaluka (Blantyre, Malawi), Prof Lorna Renner (Accra, Ghana), Dr Vivian Paintsil (Kumasi, Ghana), Dr Francine Kouya (Cameroon), Dr Festus Njuguna (Eldoret, Kenya), Prof Inam Chitsike (Harare, Zimbabwe)

Key activities
  • Regional training to build diagnosis capacity, especially ultrasonography training

  • Regular meetings and mentoring for teams

  • Consensus adapted treatment guideline produced

  • Central data collection and dissemination of progress

  • Nutritional assessment and support

  • Assistance with treatment and travel costs

  • Support for families through treatment

  • Follow-up of patients after completion of treatment

 

Outcomes
  • Decreased abandonment of treatment

  • Improved patient support and event-free survival

  • Increased access to timely and accurate diagnosis

  • Improved nutritional status of patients

  • Sharing progress at international meetings

  • Strong regional collaboration and support

  • Positive outcomes leading to further regional involvement

 

Impact
  • More than 260 children have so far been treated using the adapted guidelines

  • Overall survival rates have increased from 25% before the use of the guidelines, to around 50% 3)

  • Treatment abandonment has decreased from 31% to 14% by supporting families with treatment-related costs

  • Deaths during treatment have decreased from 26% to 14% through use of a uniform adapted treatment guideline

  • 8 centres in sub-Saharan Africa are using the treatment guidelines and centrally sharing their outcome data

  • Several scientific papers have been published to share the result of the trial with the pediatric oncology community

  • The support and friendship created regionally between the teams is very strong and ensures that better quality care is more sustainable

For further information, please click here.

1. Paintsil V, David H, Kambugu J, Renner L, Kouya F, Eden T, et al. The Collaborative Wilms Tumour Africa Project; baseline evaluation of Wilms tumour treatment and outcome in eight institutes in sub-Saharan Africa. Eur J Cancer. 2015;51(1):84-91.

2. Israels T, Kambugu J, Kouya F, El-Mallawany NK, Hesseling PB, Kaspers GJ, et al. Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa. Nat Rev Clin Oncol. 2013;10(10):599-604.

3. Israels T, Paintsil V, Nyirenda D, Kouya F, Mbah Afungchwi G, Hesseling P, et al. Improved outcome at end of treatment in the collaborative Wilms tumour Africa project. Pediatr Blood Cancer. 2018.

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