Delayed referral and treatment of paediatric cancer in Nigeria: Time to stop blaming the victim

Background: Caregiver delay in presentation has been cited as a major contributor to poor prognosis of paediatric cancers in low-middle income countries like Nigeria. This study explored the time duration between onset of symptoms and presentation to healthcare facilities, diagnosis, and referral for specialist care. Methods: Data were compiled from caregivers of newly registered children at a teaching hospital in Nigeria. Sociodemographic and clinical history of the child were taken. Type of cancer, date of diagnosis, centre where the diagnosis was made, treatment start date, and duration of symptoms until treatment were elicited from consenting caregivers and documented. Results: Acute lymphoblastic leukaemia was the most prevalent cancer type among the patients. The mean time from first symptom to presentation was 15 weeks and from presentation at any health care facility to specialist referral and diagnosis was 38 and 39 weeks, respectively. Time from diagnosis to treatment was a mean of 8 weeks (range: 1 to 27 weeks) Conclusion: Delayed presentation has become a commonly cited factor for poor cancer outcomes in Nigeria and may often inaccurately assign blame to the patient/caregivers. The results of this study point to delayed detection, delayed diagnosis and delayed referral for specialist care, as more accurate contributors to late-stage presentation and consequently worse outcomes of paediatric cancers in Nigeria. Strengthening of community and primary level healthcare professionals’ understanding of paediatric cancers, establishment of simple detection algorithms and national implementation of efficient referral protocols will potentially reduce delays in specialist attention and improve outcomes

Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

Abstract Background The shortage of skilled healthcare professionals in pediatric oncology and the limited access to training programs remain significant challenges in Nigeria and sub-Saharan Africa. The the Pediatric Radiation Oncology (Virtual) Course, ‘PedROC’ project aims to contribute to improving pediatric cancer outcomes in Nigeria by increasing the capacity of radiation oncology professionals. To address the gap in access to pediatric radiation oncology professional development, the PedROC project was created, harnessing technology to improve radiation oncology training via a curriculum delivered through web-conferencing. This study aimed to evaluate the effectiveness of the PedROC pilot in enhancing the capacity, confidence, and skill of radiation oncologists in decision-making, prescribing, and treatment planning of radiotherapy for children diagnosed with cancer. Methods A multidisciplinary faculty of specialists in radiation oncology, pediatric oncology, oncology nursing, radiation therapy technology, and medical physics collaborated to identify the key learning needs in pediatric radiation oncology in the country. The team collaborated to develop a comprehensive curriculum covering the most common pediatric cancers in sub-Saharan Africa for the training program. The training course was conducted over two days, delivering twenty-four half-hour sessions for a total of 12 h, from July 31 to August 01, 2021. Results Analysis of pre and post - training surveys showed a significant increase in self-reported confidence measures across all domains among radiation oncologists. The program successfully improved participants’ knowledge and confidence levels in managing common pediatric cancers using radiotherapy, particularly addressing radiotherapy-specific issues such as appropriate dose, target volume delineation, treatment planning, dose constraints, and plan evaluation. Conclusion The PedROC pilot showed the efficacy of this model in enhancing the capacity and confidence of radiation oncology professionals involved in the treatment of pediatric cancer. The findings indicate that technology holds significant potential to increase pediatric radiation oncology capacity in Africa, ensuring improved access to proper treatment and ultimately improving pediatric cancer outcomes