Extracranial germ cell tumours : mature and immature (1990–2015). First report by the South African Association of Paediatric Haematology Oncology (SAAPHO)

DATA AVAILABILITY STATEMENT : Data restricted due to ethical considerations, but reasonable requests will be considered by the corresponding author and only with the express consent of the South African Association of Paediatric Haematology Oncology (SAAPHO).BACKGROUND AND OBJECTIVES : Outcomes of rare paediatric teratomas have not previously been reported nor treatment regimens standardised in low- and middle-income settings. We sought to evaluate treatment outcomes of children and adolescents with histologically confirmed extracranial germ cell tumours, both mature teratomas (MT) and immature teratomas (IT) in preparation for the development of the South African national treatment guideline. METHODS : Retrospective data by folder review were collated from nine South African paediatric oncology units. Kaplan–Meier analysis with Cox regression was performed to determine 5-year overall survival (OS) and prognostic factors. RESULTS : From January 1990 to December 2015, 60 patients were diagnosed with MTs; 14 males (median age 2 months; interquartile range [IQR]: 0–8.75 months) and 46 females (median age 9 months; IQR: 0–88.5 months). Forty patients were diagnosed with ITs; 10 males (median age less than 1 month; IQR: 0–1.75 months) and 30 females (median age 4.5 months; IQR: 1–162 months). There were high rates of upfront surgical resections in patients with MTs (58/60; 96.6%) and ITs (36/40; 90%), and similarly satisfactory rates of complete resection in patients with both MTs (55/60; 91.7%) and ITs (32/40; 80%). The 5-year OS for the whole group was 85.4%, significantly influenced by stage: Stage I (96.9%), Stage II (100%), Stage III (38.9%) (p < .001 [MT]; p = .013 [IT]). The event-free survival (EFS) ratio for the whole cohort was 78.7%. CONCLUSIONS : Five-year OS for those with low-stage disease was excellent, but was poorer for patients with advanced disease. The implementation of a national treatment guideline will facilitate the standardising of surgical approaches, indications for chemotherapy and specifications for follow-up to improve survival and to collect more robust late effects data.The National Research foundation; Harry Crossley Foundation and Professor Bongani Mayosi Netcare Clinical Scholarship.https://wileyonlinelibrary.com/journal/pbchj2024Paediatrics and Child HealthSDG-03:Good heatlh and well-bein

A community grounded HIA: The benefits of conducting a HIA during the Airds Bradbury Estate Redevelopment

Background This paper identifies and discusses the benefits of taking a ‘community grounded’ approach to HIA in the context of a place based urban renewal setting and reflect on whether this is a useful approach for people and organisations wishing to undertake HIA’s in similar settings. The HIA was on the redevelopment of the suburban town centre and focussed on the creation of a new multipurpose centre, improvements to a manmade pond and the relocation of sporting fields found in the area. The HIA team aimed to explore what the planned redevelopment of the local town centre area would mean for the local community and its potential health impacts upon residents.   Methods The HIA followed the standard HIA steps. The HIA team took a community grounded approach where particular focus was give to engaging community members in the HIA process. This included community members being involved in the HIA working group, reference group and providing evidence for the HIA.   Results The HIA report contained a series of recommendations for the redevelopment of the Airds Bradbury estate. These recommendations were presented to the Community Reference Group and were adopted by various stakeholders.   Conclusions   The community grounded approach influenced both how the HIA was carried out, the decisions that were made within the HIA and ultimately the finidings and recomendations. The HIA of this latest stage of the Airds-Bradbury estate redevelopment was a useful project to encourage further collaboration, dialogue and planning between redevelopment agencies, Local Government, and residents of the Airds Bradbury social housing estate

Australian and Canadian financial wellbeing policy landscape during COVID-19: An equity-informed policy scan

Background: This targeted and comprehensive policy scan examined how different levels of governments in Australia and Canada responded to the financial crisis brought on by the COVID-19 pandemic. We mapped the types of early policy responses addressing financial strain and promoting financial wellbeing. We also examined their equity considerations. Methods: Through a systematic search, snowballing, and manual search, we identified Canadian and Australian policies at all government levels related to financial strain or financial wellbeing enacted or amended in 2019–2020. Using a deductive-inductive approach, policies were categorized by jurisdiction level, focal areas, and target population groups. Results: In total, 213 and 97 policies in Canada and Australia, respectively, were included. Comparisons between Canadian and Australian policies indicated a more diversified and equity-targeted policy landscape in Canada. In both countries, most policies focused on individual and family finances, followed by housing and employment areas. Conclusions: The policy scan identified gaps and missed opportunities in the early policies related to financial strain and financial wellbeing. While fast, temporary actions addressed individuals’ immediate needs, we recommend governments develop a longer-term action plan to tackle the root causes of financial strain and poor financial wellbeing for better health and non-health crisis preparedness. Statement on Ethics and Informed Consent: This research reported in this paper did not require ethical clearance or patient informed consent as the data sources were published policy documents. This study did not involve data collection with humans (or animals), nor any secondary datasets involving data provided by humans (or from animal studies)

Sex cord stromal tumors in children and adolescents : a first report by the South African Children's Cancer Study Group (1990-2015)

OBJECTIVES : Pediatric sex cord stromal tumors (SCSTs) are extremely rare and there are no reported data from Africa. The authors evaluated the outcomes of children and adolescents with biopsy-proven SCSTs in preparation for the introduction of a national protocol. MATERIALS AND METHODS : Retrospective data were collated from 9 South African pediatric oncology units from January 1990 to December 2015. Kaplan-Meier analysis was performed to estimate overall survival (OS) and event-free survival. RESULTS : Twenty-three patients were diagnosed with SCSTs, 3 male and 20 female individuals, during the study period. Histologies included 1 thecoma, 9 Sertoli-Leydig cell tumors, and 13 juvenile granulosa cell tumors. Stage I tumors predominated (n=14; 60.9%), with 2 stage II (8.7%), 5 stage III (21.7%), and 2 stage IV tumors (8.7%). The upfront resection rate was 91.3% with no reported surgical morbidity or mortality and an OS of 82.1%. Chemotherapy approaches were not standardized. Most children (81.8%), except 2, had recognized platinum-based regimens. Chemotherapy-related toxicity was minimal and acceptable. Assessment of glomerular filtration rate and audiology assessments were infrequent and not standardized. Three patients were lost to follow-up. CONCLUSIONS : Although the numbers in this cohort are small, this study represents the first national cohort in Africa. The 5-year OS of 82.1% was encouraging. Standardized management of rare tumors like SCSTs is critical to improve ensure OS and address potential long-term sequelae.The National Research Foundation of South Africahttp://journals.lww.com/jpho-online/pages/default.aspx2022-07-01hj2021Paediatrics and Child Healt

Malignant extracranial germ cell tumours : a first national report by the South African Children's Cancer Study Group

DATA AVAILABILITY STATEMENT : Data restricted due to ethical considerations but reasonable requests will be considered by the corresponding author and only with the express consent of the South African Children's Cancer Study Group (SACCSG).SUPPORTING TABLE S1. Chemotherapy-related complications.OBJECTIVE : To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol. METHODS : A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy-proven MEGCTs from birth up to and including 16 years of age. RESULTS : Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (hazard ratio [HR] 0.284, p = .037) and higher socio-economic status (SES) (HR 0.071, p = .039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I: 96%; stage II: 94.3%; stage III: 75.5% (p = .017) and stage IV (60.1%; p < .001). There was a significant association between earlier stage at presentation and higher SES (p = .03). Patients with a serum alpha-fetoprotein (AFP) level of more than 33,000 ng/ml at diagnosis had significantly poorer outcomes (p = .002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p < .001). CONCLUSIONS : The cohort demonstrated a 5-year OS of 80.3% with an event-free survival (EFS) of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000 ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide.The National Research Foundation, the Harry Crossley Foundation, University of Cape Town, and The Professor Bongani Mayosi Netcare Clinical Scholarship.https://wileyonlinelibrary.com/journal/pbchj2023Paediatrics and Child Healt

Extracranial germ cell tumours: mature and immature (1990-2015) : first report by the South African Association of Paediatric Haematology Oncology (SAAPHO)

Abstract: Background and objectives: Outcomes of rare paediatric teratomas have not previously been reported nor treatment regimens standardised in low- and middle-income settings. We sought to evaluate treatment outcomes of children and adolescents with histologically confirmed extracranial germ cell tumours, both mature teratomas (MT) and immature teratomas (IT) in preparation for the development of the South African national treatment guideline.Methods: Retrospective data by folder review were collated from nine South African paediatric oncology units. Kaplan-Meier analysis with Cox regression was performed to determine 5-year overall survival (OS) and prognostic factors.Results: From January 1990 to December 2015, 60 patients were diagnosed with MTs; 14 males (median age 2 months; interquartile range [IQR]: 0-8.75 months) and 46 females (median age 9 months; IQR: 0-88.5 months). Forty patients were diagnosed with ITs; 10 males (median age less than 1 month; IQR: 0-1.75 months) and 30 females (median age 4.5 months; IQR: 1-162 months). There were high rates of upfront surgical resections in patients with MTs (58/60; 96.6%) and ITs (36/40; 90%), and similarly satisfactory rates of complete resection in patients with both MTs (55/60; 91.7%) and ITs (32/40; 80%). The 5-year OS for the whole group was 85.4%, significantly influenced by stage: Stage I (96.9%), Stage II (100%), Stage III (38.9%) (p < .001 [MT]; p = .013 [IT]). The event-free survival (EFS) ratio for the whole cohort was 78.7%.Conclusions: Five-year OS for those with low-stage disease was excellent, but was poorer for patients with advanced disease. The implementation of a national treatment guideline will facilitate the standardising of surgical approaches, indications for chemotherapy and specifications for follow-up to improve survival and to collect more robust late effects data