642 - Treatment-Related Mortality in Children with Cancer in Low- and Middle-Income Countries: A Meta-Analysis

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 642
Publication Number: 642.316

Bella Ehrlich, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Michael J. McNeil, St. Jude Children's Research Hospital, Memphis, TN, United States; Jocelyn Rivera, Hospital Infantil Teletón de Oncología, QUERETARO, Queretaro de Arteaga, Mexico; Carlos Acuna, Dr Luis Calvo Mackenna Hospital, santiago, Region Metropolitana, Chile; Liz Sniderman, Stollery Children’s Hospital, Edmonton, AB, Canada; Firas M. Sakaan, St. Jude Children's Research Hospital, Memphis, TN, United States; Alejandra Méndez Aceituno, Unidad Nacional de Oncología Pediátrica, Guatemala, Jutiapa, Guatemala; César A.. Villegas, St. Jude Children's Research Hospital, Arlington, TN, United States; Linh Pham, St. Jude Children's Research Hospital, Memphis, TN, United States; Lisa M. Force, University of Washington School of Medicine, Seattle, WA, United States; Nancy S.. Bolous, St. Jude Children's Research Hospital, Memphis, TN, United States; Parima P. Wiphatphumiprates, St. Jude Children's Research Hospital, Nashville, TN, United States; Jeremy Slone, St. Jude Children's Research Hospital, Memphis, TN, United States; Srinithya R. Gillipelli, Baylor College of Medicine, Houston, TX, United States; Caitlyn Duffy, St. Jude Children’s Research Hospital, Memphis, TN, United States; Anita V.. Arias, St. Jude Children's Research Hospital, Memphis, TN, United States; Meenakshi Devidas, St Jude Children's Research Hospital, MEMPHIS, TN, United States; Sheena Mukkada, St. Jude Children's Research Hospital, Memphis, TN, United States; Asya Agulnik, St. Jude Children's Research Hospital, Memphis, TN, United States

Presenting Author(s)

Anita V. Arias, MD (she/her/hers)

Clinical Instructor
St. Jude Children's Research Hospital
Memphis, Tennessee, United States

First Author(s)

Bella Ehrlich, BA

Medical Student
The Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States

Background: Of approximately 400,000 childhood cancer cases are diagnosed annually, 90% occur in low- and middle-income countries (LMICs), with estimated 5-year survival rates below 20%. While treatment-related mortality (TRM) in high-income countries is reported in 3-5% cases, TRM is highly variable in LMICs, with reports as high as 45%. Prior work has not explored the incidence of TRM among children with cancer in LMICs, nor primary causes of mortality.

Objective: To describe the incidence of TRM among children with cancer and primary causes of treatment-related death in LMICs.

Design/Methods: A systematic search was conducted in PubMed, Trip, Web of Science, Embase, and WHO Global Index databases to identify full text articles published between 2010-2021 describing TRM among children (0-21 years old) with cancer in LMICs. Abstracts and full-text articles were independently screened for inclusion by two reviewers in Covidence and disagreements resolved by a third investigator. Subsequently, data from eligible studies was extracted in RedCap and assessed for data quality by two reviewers. Descriptive statistics were utilized to summarize TRM and causes of death, as well as trends across cancer diagnoses over time.

Results: Of the 13,269 abstracts and 1,788 full-text articles assessed for eligibility, 503 studies were included. These studies report data from 66 countries and included a total of 68,679 children with cancer. Most common cancers included ALL (49.12%), AML (9.99%), NHL (8.85%), and retinoblastoma (7.33%). The raw TRM estimate is 10.0% (95% CI, 9.78-10.23), with leading causes of death including sepsis/infection (37.0%), induction (11.35%), and hemorrhage (5.40%). TRM was significantly higher among hematologic malignancies (11.51%) compared to non-CNS solid tumors (4.12%) and CNS tumors (2.99%). TRM was inversely related to country income group, with low income countries having higher TRM (19.0%) than lower middle-income (12.5%) and upper middle-income (8.12%) countries.

Conclusion(s): Preliminary analysis showed that approximately one out of ten children with cancer receiving treatment in LMICs dies from treatment-related complications, with TRM being highest in lower-income countries, and most deaths occurring from sepsis or infection. This study revealed wide variability in definitions and quality of reported TRM data, demonstrating a need to standardize the reporting of causes of death among children with cancer. This work is critical to classify the severity of treatment complications and inform supportive care interventions without compromising cancer survival in resource-limited settings.