Toxicity and survival rates in 75 paediatric patients with germ cell tumours treated over a 28 year period at the Charlotte Maxeke Johannesburg academic hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Paediatrics Johannesburg 2016Germ cell tumours have a good prognosis if treated aggressively but the consequence of cure may be life-altering toxicity. Prolonged duration of symptoms is often thought to contribute to poor outcomes in patients with solid tumours. Aims: To document incidence, survival rates, extent of treatment-related toxicity and to identify poor prognostic indicators in children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital. A secondary aim was to determine which classification system had validity in this cohort. Methods: A retrospective file review was conducted of children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital over a 28 year period. Descriptive statistics were employed to document incidence, toxicity rates and outcomes. Kaplan-Meier estimations were performed to determine prognostic factors. Results: Seventy five patients were identified, 17 with benign tumours, 56 with malignant tumours and two unknown. Chemotherapy was given to 48 patients, in whom 32 (67%) experienced significant myelotoxicity. Of the 41 patients treated with cisplatin, 34% developed clinically significant hearing impairment. Five patients developed renal tubular acidosis, and two developed chronic renal failure. vi The only independent factor found to have prognostic significance was complete surgical excision. There was no correlation between prolonged duration of disease-specific symptoms and poor outcome. The classification of patients according to the IGCCC system does not appear to correlate closely with determinations of prognosis, in comparison with conventional staging systems. All patients who relapsed did so in the first 3 years after diagnosis. The 3 year overall survival rate was 77.8%. There were no recorded cases of secondary malignancies or chemotherapy-induced infertility. Conclusion Complete surgical excision is vital for survival. Transient myelotoxicity and permanent hearing impairment are common when protocols incorporating cisplatin are used. Survival rates are acceptable for a middle-income country. Every effort should be made to preserve the good survival rate while decreasing toxicity.MT201

Enough is not enough: Medical students’ knowledge of early warning signs of childhood cancer

Background. The reported incidence of childhood cancer in upper-middle-income South Africa (SA) is much lower than in high-income countries, partly due to under-diagnosis and under-reporting. Documented survival rates are disturbingly low, prompting an analysis of potential factors that may be responsible.Objectives. To determine final-year medical students’ level of knowledge of early warning signs of childhood cancer and whether a correlation existed between test scores and participants’ age, gender and previous exposure to a person with cancer.Methods. A two-part questionnaire based on the Saint Siluan mnemonic, testing both recall and recognition of early warning signs of childhood cancer, was administered. The Mann-Whitney-Wilcoxon test was used to assess differences in continuous and count variables between demographic data, experience and responses, and Fisher’s exact test and Spearman’s rank correlation coefficient were used to determine correlations between demographic data, previous contact with persons with cancer and test scores. A novel equality ratio was calculated to compare the recall and recognition sections and allowed analysis of recall v. recognition.Results. The 84 participants recalled a median of six signs each (interquartile range 4 - 7) and correctly recognised a median of 70% in the recognition section, considered a pass mark. There was no correlation between participants’ age, gender, previous contact with a person with cancer and recognition scores. Students with previous exposure to a person with cancer had higher scores in the recall section, but this did not achieve statistical significance. Students were able to recognise more signs of haematological malignancies than central nervous system (CNS) malignancies.Conclusion. The study demonstrated a marked inconsistency between recall and recognition of signs of childhood cancer, with signs of CNS malignancies being least recognised. However, the majority of students could recognise enough early warning signs to meet the university pass standard. Although this study demonstrated acceptable recognition of early warning signs of childhood cancer at one university, we suggest that long-term recall in medical practitioners is poor, as reflected in the low age-standardised ratios of childhood cancer in SA. We recommend increased ongoing exposure to paediatric oncology in medical school and improved awareness programmes to increase early referrals.

Enough is not enough: Medical students’ knowledge of early warning signs of childhood cancer

Background. The reported incidence of childhood cancer in upper-middle-income South Africa (SA) is much lower than in high-income countries, partly due to under-diagnosis and under-reporting. Documented survival rates are disturbingly low, prompting an analysis of potential factors that may be responsible. Objectives. To determine final-year medical students’ level of knowledge of early warning signs of childhood cancer and whether a correlation existed between test scores and participants’ age, gender and previous exposure to a person with cancer. Methods. A two-part questionnaire based on the Saint Siluan mnemonic, testing both recall and recognition of early warning signs of childhood cancer, was administered. The Mann-Whitney-Wilcoxon test was used to assess differences in continuous and count variables between demographic data, experience and responses, and Fisher’s exact test and Spearman’s rank correlation coefficient were used to determine correlations between demographic data, previous contact with persons with cancer and test scores. A novel equality ratio was calculated to compare the recall and recognition sections and allowed analysis of recall v. recognition. Results. The 84 participants recalled a median of six signs each (interquartile range 4 - 7) and correctly recognised a median of 70% in the recognition section, considered a pass mark. There was no correlation between participants’ age, gender, previous contact with a person with cancer and recognition scores. Students with previous exposure to a person with cancer had higher scores in the recall section, but this did not achieve statistical significance. Students were able to recognise more signs of haematological malignancies than central nervous system (CNS) malignancies. Conclusion. The study demonstrated a marked inconsistency between recall and recognition of signs of childhood cancer, with signs of CNS malignancies being least recognised. However, the majority of students could recognise enough early warning signs to meet the university pass standard. Although this study demonstrated acceptable recognition of early warning signs of childhood cancer at one university, we suggest that long-term recall in medical practitioners is poor, as reflected in the low age-standardised ratios of childhood cancer in SA. We recommend increased ongoing exposure to paediatric oncology in medical school and improved awareness programmes to increase early referrals

Prognostic factors affecting survival in children and adolescents with HIV and Hodgkin lymphoma in South Africa

South African children with Hodgkin lymphoma (HL) and human immunodeficiency virus (HIV) have low 5-year overall survival (OS) rates. In this retrospective multicenter study, 271 South African pediatric patients with HL were studied to determine OS and prognostic factors in those with HIV and HL. Univariate risk factor analysis was performed to analyze prognostic factors. The 29 HIV-infected patients were younger (p = .021), more likely to present with wasting (0.0573), stunting (0.0332), and Stage IV disease (p = .000) than HIV-uninfected patients. The 5- and 10-year OS of HIV-infected patients of 49% and 45% versus 84% and 79%, respectively for HIV-uninfected patients (p = .0001) appeared to be associated with hypoalbuminemia (<20 g/dL) and CD4 percentage of <15%. Causes of death in the HIV-infected group included disease progression (6/14), infection (4/14), unknown (3/14), and second malignancy (1/14). HIV-infected pediatric patients with HL experience increased mortality due to post-therapy opportunistic and nosocomial infections.CANSA (Cancer Association of South Africa) and the Carnegie Corporation Research Fund.https://www.tandfonline.com/loi/ilal20hj2022Paediatrics and Child Healt