Childhood cancer incidence and survival in Thailand: A comprehensive population‐based registry analysis, 1990–2011

BackgroundSoutheast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20‐year period.MethodsCancer cases diagnosed in children ages 0‐19 years (n = 3574) from 1990 to 2011 were extracted from five provincial population‐based Thai registries, covering approximately 10% of the population. Descriptive statistics of the quality of the registries were evaluated. Age‐standardized incidence rates (ASRs) were calculated using the Segi world standard population, and relative survival was computed using the Kaplan‐Meier method. Changes in incidence and survival were analyzed using Joinpoint Regression and reported as annual percent changes (APC).ResultsThe ASR of all childhood cancers during the study period was 98.5 per million person‐years with 91.0 per million person‐years in 1990–2000 and 106.2 per million person‐years in 2001–2011. Incidence of all childhood cancers increased significantly (APC = 1.2%, P < 0.01). The top three cancer groups were leukemias, brain tumors, and lymphomas. The 5‐year survival for all childhood cancers significantly improved from 39.4% in 1990–2000 to 47.2% in 2001–2011 (P < 0.01).ConclusionsBoth childhood cancer incidence and survival rates have increased, suggesting improvement in the health care system as more cases are identified and treated. Analyzing childhood cancer trends in low‐ and middle‐income countries can improve understanding of cancer etiology and pediatric health care disparities.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146559/1/pbc27428_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146559/2/pbc27428.pd

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

Objective: To appraise the experience of a pediatric cancer center in Thailand regarding employment of totally implantable venous access devices (TIVAD). Methods: The records of consecutive patients aged less than 15 years diagnosed malignancy and underwent an implantation from the years 2010 to 2018 were reviewed with the main focus on effective duration and complications of the device. Changes in our practice in perioperative care were also reviewed. Results: A total of 150 lines in 144 patients (103 hematologic malignancies and 41 solid tumors) were included with average age 6.4 years. Neck vein access was used in 62 lines, subclavian vein access in 88 lines. The median follow-up period was 973 days. Immediate complications occurred in 13 cases (9.4%). Excluding cases with death from unrelated causes, the overall TIVAD survival was 985.1 days while event-free device survival was 797.6 days. In cases of hematologic malignancies, which were the main users, 1000-day overall survival and event-free survival of TIVAD were 83.7% and 78.2%, respectively. Catheter-related infections and mechanical obstruction were the 2 most prevalent problems, occurring in 0.20 and 0.08 events/1,000 catheter days, respectively. Infection occurred in 23 patients and gram-negative bacilli were most common. Moreover, subclavian access was significantly related with infectious complications when compared to the neck vein approach. Conclusion: A TIVAD can be used for chemotherapy longer than 3 years without serious complications. Refinement of surgical techniques and improving care process may improve the longevity of the line

Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes

Hyperleukocytosis and extreme hyperleukocytosis, defined as initial white blood cell counts greater than 100 × 109/L and 200 × 109/L, respectively, have been associated with unfavorable outcomes. This study aimed to determine the early complications and survival outcomes of childhood leukemia patients with hyperleukocytosis. The medical records of 690 children newly diagnosed with acute leukemia between January 1998 and December 2017 were retrospectively reviewed. The Kaplan–Meier method and log-rank test were used to assess and compare the survival outcomes. Multivariate Cox proportional hazards regression was used to determine associated risk factors for overall survival. We found that 16.6% of 483 childhood acute lymphoblastic leukemia (ALL) patients and 20.3% of 207 childhood acute myeloid leukemia (AML) patients had hyperleukocytosis at diagnosis. ALL patients with hyperleukocytosis had more early complications than those without hyperleukocytosis (p p p = 0.26). Hyperleukocytosis (hazard ratio [HR]: 2.04), extreme hyperleukocytosis (HR: 2.71), age less than 1 year (HR: 3.05), age greater than 10 years (HR: 1.64), and male sex (HR: 1.37) were independently associated with poorer overall survival in childhood ALL patients. Extreme hyperleukocytosis (HR: 2.63) and age less than 1 year (HR: 1.82) were independently associated with poorer overall survival in AML patients. Hyperleukocytosis was associated with adverse survival outcomes in childhood leukemia

Childhood cancer incidence and survival in Thailand: A comprehensive population-based registry analysis, 1990–2011

Background: Southeast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20-year period. Methods: Cancer cases diagnosed in children ages 0-19 years (n = 3574) from 1990 to 2011 were extracted from five provincial population-based Thai registries, covering approximately 10% of the population. Descriptive statistics of the quality of the registries were evaluated. Age-standardized incidence rates (ASRs) were calculated using the Segi world standard population, and relative survival was computed using the Kaplan-Meier method. Changes in incidence and survival were analyzed using Joinpoint Regression and reported as annual percent changes (APC). Results: The ASR of all childhood cancers during the study period was 98.5 per million person-years with 91.0 per million person-years in 1990–2000 and 106.2 per million person-years in 2001–2011. Incidence of all childhood cancers increased significantly (APC = 1.2%, P \u3c 0.01). The top three cancer groups were leukemias, brain tumors, and lymphomas. The 5-year survival for all childhood cancers significantly improved from 39.4% in 1990–2000 to 47.2% in 2001–2011 (P \u3c 0.01). Conclusions: Both childhood cancer incidence and survival rates have increased, suggesting improvement in the health care system as more cases are identified and treated. Analyzing childhood cancer trends in low- and middle-income countries can improve understanding of cancer etiology and pediatric health care disparities