Temporal trends in childhood cancer survival in Egypt, 2007-2017: a large retrospective study of 14,808 children with cancer from the Children's Cancer Hospital-Egypt.
Soliman R., Elhaddad A., Oke J., Eweida W., Sidhom I., Ahmed S., Abdelrahman H., Moussa E., Fawzy M., Zamzam M., Zekri W., Hafez H., Sedky M., Abdalla A., Hammad M., Elzomor H., Ahmed S., Awad M., Abdelhameed S., Mohsen E., Shalaby L., Fouad H., Tarek N., Abouelnaga S., Heneghan C.
Childhood cancer is a priority in Egypt due to large numbers of children with cancer, sub-optimal care and insufficient resources. It is difficult to evaluate progress in survival due to paucity of data in national cancer registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n=15,779, aged 0-18 years) from Egypt between 2007-2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40-50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14,808 eligible patients using Kaplan Meier method, and determined survival trends using Cox regression by single year of diagnosis, and diagnosis periods. We compared age-standardized rates to international benchmarks in England and the US, identified cancers with inferior survival, and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (p<0.001), and by calendar periods from 69.6% to 74.2% (p<0.0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumours, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (p<0.001) than England and the US, respectively. Significantly inferior survival was observed for the majority of cancers. Although, survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior to high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy. This article is protected by copyright. All rights reserved.