Chemotherapy-Induced Toxicities in Pediatric Cancer Patients: A Cross-Sectional Survey Using a Child- and Caregiver-Reported Outcome Tool in Tanzania.

Abstract

Background: Chemotherapy remains the cornerstone of pediatric cancer treatment, yet its cytotoxic nature often results in chemotherapy-induced toxicities, adverse effects arising from damage to healthy, rapidly dividing cells. Data describing these toxicities from the patient and caregiver perspective are scarce in sub-Saharan Africa. This study assessed the types, severity, and determinants of Chemotherapy-Induced Toxicities among pediatric cancer patients in Tanzania.

Methodology: A descriptive cross-sectional study was conducted over six months at Bugando Medical Center. Pediatric patients aged birth to 18 years receiving chemotherapy were enrolled. Toxicities were assessed using a locally validated, Swahili-translated version of the Pediatric Patient-Reported Outcomes Common Terminology Criteria for Adverse Events tool. Children aged ≥ 7 years self-reported their symptoms, while caregivers provided proxy reports for younger children and those who can not express themselves. Associations between chemotherapy-induced toxicities and demographic or treatment variables were analysed using multivariate logistic regression to adjust for potential confounding factors or variables (p < 0.05).

Results: Of 120 participants (55.8% male), all experienced at least one Chemotherapy-Induced Toxicity, with a mean of five per participant. The most common toxicities were alopecia (82.5%), taste changes (74.2%), vomiting (44.2%), and nausea (35%). Most events were mild (grade 1). In multivariable analysis, cancer classification was the only significant predictor of toxicity, with solid tumors showing higher odds of ≥ Grade 2 Chemotherapy-induced toxicities compared with hematologic cancers (AOR = 7.42, p = 0.047). Other factors showed no statistically significant associations.

Conclusion: Chemotherapy-induced toxicities were frequent, with most children experiencing multiple symptoms across organ systems. Cancer classification was the only factor significantly associated with higher-grade toxicities. Integrating child- and caregiver-reported outcome measures into pediatric oncology practice could enhance early identification of toxicities, support timely management, and inform national strategies to improve treatment safety and quality of life for children with cancer in Tanzania.