ORIGINAL

Niger J Paed 2012; 39 (2):60 - 62

Offiong UM

Childhood malignancies in University of

Abuja Teaching Hospital Gwagwalada,

Abuja, Nigeria.

DOI:http://dx.doi.org/10.4314/njp.v39i2.4

motherapy. Of these, 6.5 percent

n=3) completed therapy. Twenty

nine percent of patients died. 4

percent of those that died had com-

menced chemotherapy. There was a

Received: 22nd May 2011

Accepted: 20th December 2011

Abstract: Background: Mortality

from malignancies in children re-

mains high. Creating awareness of

the disease and advocacy for fund-

ing of a cancer research center are

pertinent.

Objective: To determine the inci-

dence and outcome of children with

cancers at the University of Abuja

Teaching Hospital, Gwagwaglada,

Abuja- FCT, Nigeria

Method: This was a 5 year prospec-

tive study of all diagnosed cancer

patients admitted into the paediat-

ric ward. The type of cancer,

method of diagnosis, clinical stag-

ing and outcomes were entered and

frequency tables generated on Mi-

crosoft Excel.

Results: Forty-six patients were

diagnosed with cancer within the

study period. Burkitt's lymphoma

was the highest encountred malig-

nancy, while medulloblastoma was

least occurring. Only 36.9 percent

(

)

Offiong U.M

Department of Paediatrics,

University of Abuja Teaching

Hospital,

PMB 228 Abuja FCT

Email: uroffiong@yahoo.com

Tel: +2348036184216

7

0 percent treatment default rate.

One patient was referred on request

to another tertiary center. All other

patients were lost to follow up.

Conclusion: Management of child-

hood cancers still poses a problem.

Poverty, ignorance and lack of can-

cer research units contributed to our

poor outcome. The greater involve-

ment of government and interna-

tional non-governmental organiza-

tions (NGO) which assist health

sector is advocated in the establish-

ment of cancer research centers and

the provision of free chemothera-

peutic agents.

Key words: Cancers, mortality,

Advocacy

(

N=17) of patients received che-

Introduction

mained high in developing countries. It is estimated that

2 out of 3 children with cancers treated in western coun-

Cancers in children make up a small proportion of the

total admissions in paediatric wards, however the mor-

tality rates from this disease is high. Poverty, ignorance

and superstition and poorly equipped health facilities are

factors that continue to con₁t_,r₂i_,₃bute to the poor outcome

of patients with this disease.

tries will be cured, but with the cost of therapy being out

of the reach of many children, d₄eath from disease is

likely to occur in African children.

This study carried out in a hospital in north central re-

gion of Nigeria to determine the incidence and outcome

of cancers in children seen and to highlights the difficul-

ties encountered in the management of paediatric can-

cers.

In Nigeria, the management of cancers is still froth with

the problems of poor diagnostic facilities, high cost of

drugs, coupled with ignorance, late presentation and

poverty leading to continuing poor patient outcome.

Furthermore, there are few paediatric oncologists and

cancer research and treatment units which makes cancer

care a problem for the general practice paediatrician.

This also hinders research in cancers.

Method

This is a 5- year prospective study carried out in the

Department of Paediatrics University of Abuja Teaching

Hospital (UATH) Gwagwalada between May 2000 to

May 2005. The peaditric department has 110 beds and

While mortality rates in developed nations are improv-

ing due to better management techniques, newer, more

potent drugs and adjuvant therapies, mortality has re-

6

1

offers all levels of care. The age limit in the department

is 15years.

Table 1: Incidence of Cancers in Children

Cancer type

Number

%(n=46)

All paediatric patients with presumed malignancies

admitted into the paediatric ward were recruited in the

study. There were no exclusion criteria. Consent was

obtained from the medical ethics committee of the hos-

pital.

Burkitts

Non Hodgkins

Hodgkins

Nephroblastoma

Neuroblastoma

Acute leukemia

Retinoblastoma

Osteogenic sarcoma

Medulloblastoma

20

4

3

7

1

6

1

43.5

8.7

6.5

15.2

2.2

13.0

2.2

The cancer type, method of diagnosis, treatment

(

based on exsisting protocol), and outcome and follow

up findings were entered into a data sheet. Clinical ex-

amination, surgical findings, radiological films and his-

tology were used in the staging of cancer where possi-

ble.

2.2

Counseling of patient's caregiver was done in the pri-

mary language of communication once a diagnosis was

made and before the commencement of treatment.

Counseling included an explanation of what cancers

were, the stage of patient's cancers, the pre - chemother-

apy requirements, management of complications that

could arise as a result of chemotherapy and the need to

complete chemotherapy. The possible outcomes and

monetary implications were also discussed.

Seventeen patients (36.9 percent) received chemother-

apy, of which three (17.6 percent) completed their

course and 11 (70.5 percent) defaulted from treatment

while three died (17.6 percent). No patient attended fol-

low-up in the oncology clinic. Table 2 summarizes the

patient outcome.

Of the 29 patients who did not receive treatment, 22

(75.9 percent) left against medical advice. None pre-

sented for re-admission or to the Oncology clinic.

The main method of tissue sampling was by fine needle

aspiration biopsy (FNAB). Bone marrow aspiration and

tissue biopsy were done where possible. Full blood

counts, and radiologic films were also used as tools of

diagnosis.

Ten (21.7 percent) children died, seven before the com-

mencement of chemotherapy and three after the com-

mencement chemotherapy.

Data was entered into microsoft excel 2007. Results

were displayed as frequency tables.

Table 2: Overview of patient treatment and outcome

(N=46)

Number of

patients

%

Patients who received

chemotherapy

Results

17

29

36.9

63.0

There were 53 children admitted for persumed cancers,

only forty-six (46) had confirmed malignancies. FNAB

was used to diagnose 23 patients, bone marrow aspira-

tion five, tissue biopsy in 15 and radiologic investiga-

tions provided diagnosis in two while one had diagnosis

confirmed with blood film picture.

Patients who did not receive

chemotherapy

Patients that left against medical

advice without treatment

Number who died while on

admission

22

10

47.8

21.7

There were 17 females and 29 males. The over-all M:F

ratio was 1.7:1. Their ages ranged between 0.6 years to

1

4 years with an average age of 6.6 years.

Table 1 shows the types of cancers and the frequency of

their occurrence. Lymphomas made up 58.7 percent

Discussion

(

n=27) of the cancers with Burkitts accounting for 74

In this 5-year study, the number of cases diagnosed was

comparable to studies done in other regions of Nigeria

(most of which were done more than a decade ago).

percent of this while it accounted for 43.5 percent of the

total cancers recorded. The two others had histologic

reports of blue cell tumors without definitive diagnosis

of cancer type. Eleven (23%) children presented with

early stages of disease. Among these were eight with

stage A Burkitts lymphoma (Zigler's classification), one

with L2 leukemia (FAB classification) and two with

stage I and II of Nephroblastoma (the National Wilms

Tumor Study Group) .

1

-7,12

These numbers are considerably lower however than

the number of ne_,₉w cases per year seen in some devel-

8

oped countries. The existence of a National cancer

registry in those countries helps greatly to kept accurate

statistic of the disease burden.

Issues of ignorance, poverty or superstition, which may

cause parents to seek alternative forms of therapy thus

6

2

not presenting in hospitals, further mitigates against the

capturing of accurate statistics. Lack of diagnostic facili-

ties with death occurring before diagnosis or non-

diagnosis, also compounds the numbers of missed cases.

During this study period, there were several industrial

actions which further affected the number of patients

enrolled.

The default rate in this study was quite₁h_,₂igh. This is not

however uncommon in other studies . With such a

high default rate, less than 8% of patients benefited from

drug therapy. The high default rates recorded maybe

again attributable to poverty and in some cases parental

fatigue. Patients defaulting from treatment makes it dif-

ficult to determine whether drugs and regimens are ef-

fective in the treatment of childhood cancers in this re-

gion and thus difficult to determine cure rates in this

environment.

The pattern of childhood cancers in Nigeria has re-

mained largely unchanged over the last 40 years with

Burkitts lymphom₁_,a₃_,₄_,b₇_,e₁₂ing the predominant cancer in

Nigerian children

. This was also shown in this

Couns₇eling is known to effectively engage patient in

1

study. The mortality rate in this study though low may

not be a true rate. Within the period of study, many par-

ents withdrew their children from hospital while an

equally high number never returned to complete treat-

ment. Death at home or in seeking alternative therapy

would also have occurred in most cases.

care. However despite pretreatment counceling, the

desired outcome did not occur in this study as default

rates and rates of discharge without the benefit of ther-

apy was high.

Cancer is a health problem in Nigeria which continues

to suffer neglect. As in most developing countries, it is

considered a low priority disease as it grapples for fi-

nacial resources with₈communicable diseases and envi-

Paediatric c₂_,a₁₁n_-c₁₂er patients pose a lot₁o_-f₆_,₁c₄oncern to pae-

diatricians.

As in other studies

late presenta-

1

tions with advanced disease compounded by delays in

establishing a diagnosis and starting treatment were also

problems encountered in management in this study.

ronmental sanitation. With the involvement of many

donor agencies in the eradication of childhood diseases,

the setting up of cancer research and treatment centers is

strongly advocated. Also policies that would support

free treatment for children are recommended.

The major mode of diagnosis was percutaneous fine

needle aspiration. This method is a quic₁k₅_,₁₆effective and

inexpensive alternative to open biopsy.

Proper stag-

ing was incomplete in most patients. This was due both

to a lack of facilities and death.

Conflict of interest : None

Funding : None

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