Browsing by Author "Stones, D. K."
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- ItemChildhood cancer incidence in South Africa, 1987 - 2007(Health & Medical Publishing Group, 2015) Stefan, D. C.; Stones, D. K.; Wainwright, D.; Kruger, Mariana; Davidson, A.; Poole, J.; Hadley, G. P.; Forman, D.; Colombet, M.; Steliarova-Foucher, E.Background. Childhood cancer is an emerging problem in Africa. Its extent is hazy because data are scarce, but it should be addressed. This is the first report from the South African Children’s Tumour Registry (SACTR), which covers the whole of South Africa (SA). It provides minimal estimates of cancer incidence and discusses the challenges of cancer surveillance and control in a child population in a middle-income country. Only about 2% of the African population is covered by cancer registries producing comparable incidence data. Objective. To present and interpret incidence patterns and trends of childhood cancer over a 21-year period. The results should raise awareness of the problem of childhood cancer in an African population and provide sensible data for taking this problem in hand. Methods. All eligible and validated cancer cases registered in the SACTR over the period 1987 - 2007 and classified according to the International Classification of Childhood Cancer were included. Population data were retrieved from official sources and estimated for the population subcategories. Incidence rates were standardised to the world standard and time trends were evaluated using joinpoint models, adjusting for sex and age. Results. Based on the 11 699 cases, the overall age-standardised average annual incidence rate was 45 per million. Threefold differences in the overall incidence rates were observed between the ethnic groups, ranging from 116 for whites to 37 for black Africans, and they differed by diagnostic group. Differences between the nine provinces of SA relate to the ethnic composition and prevailing socioeconomic status. The overall incidence rate declined by 1.2% per year for the whole country (p<0.01). However, the decline was mainly observed during the first few years of the study period, after which rates stabilised or increased. Conclusions. Diagnosis and notification of childhood cancer should improve. The differences in incidence between ethnic groups suggest the priorities for cancer control.
- ItemThe cost of nephroblastoma treatment in South Africa : a very cost-effective investment with guidelines for the rest of Africa(Health & Medical Publishing Group, 2014-11-13) Stefan, Daniela Cristina; Stones, D. K.; Van Zyl, A.; Uys, R.Background. Nephroblastoma is one of the most common childhood malignancies in Africa, but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita, the cost of treating nephroblastoma may be prohibitive. Objectives. To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. Methods. Data from 2000 - 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations, chemotherapy and radiotherapy, comparing early-v. advanced-stage disease. In both units, the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. Results. Stage I disease was the most common, followed by stage IV. The total cost of diagnosis, staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40), compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. Conclusion. The cost of investigation and treatment of nephroblastoma remains a challenge everywhere, but especially in Africa. However, it is a very cost-effective disease to treat and children in Africa should not be denied treatment.