Global initiative for childhood cancer focused tumors in Indonesia: A single-center study

Abstract

Background

The WHO has launched a Global Initiative to achieve 60 % childhood cancer survival in low— and middle-income countries. Their initial focus is on six highly curable types of cancer: acute lymphoblastic leukemia (ALL), Burkitt lymphoma (BL), Hodgkin lymphoma (HL), retinoblastoma, Wilms tumor (WT), and low-grade glioma (LGG). This study, therefore, investigates treatment outcomes and survival of children with highly curable cancer types in Indonesia.

Methods

Medical records of children diagnosed with curable cancer types between 2011 and 2016 at a large hospital were retrospectively abstracted until 2019.

Results

Six hundred and forty-four children were diagnosed with curable cancers: ALL (491; 76 %), retinoblastoma (61; 9 %), WT (43; 7 %), non-Hodgkin lymphoma (NHL) (43; 7 %), and HL (6; 1 %). Due to limited diagnostic tests, NHL could not be subclassified. The male-to-female ratio was 1.37. The mean age at diagnosis was 5.8 ± 4.6 years. Most (379; 59 %) had insurance at diagnosis. Event-free survival for at two years after diagnosis was 36 %. Abandonment was the most common treatment failure (26 %). The 4-year predicted event-free survival was highest for ALL (27 %) and lowest for NHL (17 %). The Cox proportional hazard model showed that cancer type (P < 0.001), age at diagnosis (P = 0.010), and health insurance coverage (P < 0.001) were associated with predicted event-free survival.

Conclusion

The current observed event-free survival of highly curable childhood cancers in Indonesia is lower than other LMICs. The main reasons for treatment failure must be addressed to improve care and achieve the envisioned 60 % cure rate.