The event-free 43.3 % is comparable to many African and third world countries. Although considered as inferior, this is a significant improvement from the previous study in Sudan1. The survival among the patients who completed therapy is good (75%) and comparable to many middle-income courtiers17. Because most patients (83%) presents with advanced disease, the recurrence rate is high (17.4%)20
There is a high rate of local recurrence, either isolated 17(68%) or with distant metastasis 6(24%). Most studies report a higher incidence due to lung relapse 21. The delay in starting radiotherapy might explain such findings.
We had one of the highest abandonment rates in Africa20,21. The cost of treatment is not the reason; because chemotherapy and radiotherapy are free. Three guesthouses provide free accommodation. The high rate of abandonment is multifactorial. The long-distance from the facility, poverty, long waiting times, anxiety about what to expect, are some reasons. Illiteracy, many social and religious believes about cancer are other reasons. Close Follow-up, including home visits when needed, might reduce this problem 21. Chagaluka et al.22 found that funds used to cover treatment, travel, and other associated costs for patients, significantly reduced the abandonment rate. In our setting, a different approach to minimize abandonment might be more useful. A project aiming at giving part of the treatment at the local hospital will be started soon. Unlike Israels T et al. 21, the death rate is lower and contributes to 11.9 % of treatment failure. The department has begun measures to improve communication with patients with poor compliance.
This study has shown the benefit of settling a specialized or semi specialized unit of pediatric oncology in low-income countries. The survival rate improved from 11% to overall survival of 43% and 75% for patients who complete therapy. There is a high abandonment rate that needs further attention. Institutionalized measures such as those adopted by L F Chukwuemeka Anyanwu, 23 might improve results The study also highlights some problems that face LIC. It emphasizes the importance of having an in-house surgical unit to reduce radiotherapy delays.
CONFLICT OF INTERESTThe authors declare that there is no conflict of interest