SACCSG HL-2018. Barriers and enablers of a harmonized treatment protocol for childhood and adolescent Hodgkin lymphoma in South Africa

Jennifer Geel; Marc Hendricks; Yasmin Goga; Beverley Neethling; Vutshilo Netshituni; Rema Mathew; Johani Vermeulen; Anel van Zyl; Fareed Omar; Jan du Plessis; Liezl du Plessis; Elelwani Madzhia; Thandeka Ngcana; Thanushree Naidoo; Lizette Louw; Daynia E Ballot; Monika L Metzger

doi:10.1080/08880018.2022.2162651

SACCSG HL-2018. Barriers and enablers of a harmonized treatment protocol for childhood and adolescent Hodgkin lymphoma in South Africa

Pediatr Hematol Oncol. 2023 Apr;40(3):300-313. doi: 10.1080/08880018.2022.2162651. Epub 2023 Jan 20.

Authors

Jennifer Geel¹, Marc Hendricks², Yasmin Goga³, Beverley Neethling⁴, Vutshilo Netshituni⁵, Rema Mathew⁶, Johani Vermeulen⁷, Anel van Zyl⁸, Fareed Omar⁹, Jan du Plessis¹⁰, Liezl du Plessis¹¹, Elelwani Madzhia¹², Thandeka Ngcana¹³, Thanushree Naidoo¹⁴, Lizette Louw¹⁵, Daynia E Ballot¹⁶, Monika L Metzger¹⁷

Affiliations

¹ Pediatric Haematology-Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
² Pediatric Haematology-Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
³ Pediatric Haematology-Oncology, University of KwaZulu-Natal, Inkosi Albert Luthuli Hospital, Durban, South Africa.
⁴ Pediatric Haematology-Oncology, University of KwaZulu-Natal, Durban, Inkosi Albert Luthuli Hospital and Greys Hospital, Pietermaritzburg, South Africa.
⁵ Pediatric Haematology-Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa.
⁶ Pediatric Haematology-Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa.
⁷ Pediatric Haematology-Oncology, Walter Sisulu University, Dora Nginza Hospital, Qheberha, South Africa.
⁸ Pediatric Haematology-Oncology, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.
⁹ Pediatric Haematology-Oncology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
¹⁰ Pediatric Haematology-Oncology, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
¹¹ Pediatric Haematology-Oncology, University of the Free State, Kimberley Hospital, Kimberley, South Africa.
¹² Pediatric Haematology-Oncology, Sefako Makgatho University, Dr George Mukhari Hospital, Garankuwa, South Africa.
¹³ Pediatric Haematology-Oncology, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
¹⁴ Department of Radiation Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁵ Department of Nuclear Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁶ School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁷ Medecins sans Frontieres, Democratic Republic of the Congo.

PMID: 36661569
DOI: 10.1080/08880018.2022.2162651

Abstract

Introduction: Collaborative studies have contributed to improved survival of pediatric Hodgkin lymphoma in well-resourced settings, but few are documented in resource-constrained countries. The South Africa Children's Cancer Study Group initiated harmonization of management protocols in 2015. This article analyzes barriers and enablers of the process. Methods: Clinician-researchers at 11 state-funded pediatric oncology units completed preparatory questionnaires in June 2018. Parameters included infrastructure, access to therapeutic modalities and clinician numbers. A reassessment of 13 sites (two new pediatric oncology unit) in February 2021 ascertained changes in resources and identified challenges to full participation. Questions investigated the presence and quality of diagnostic radiology, availability of surgeons, cytology/pathology options and hematology laboratory facilities. Results: The response rate was 11/11 to survey 1 and 13/13 to survey 2. The anticipated pre-study barriers to participation of pediatric oncology units included time constraints and understaffing. PET-CT was unavailable to two centers. The majority of pediatric oncology units met the minimum criteria to participate. The interim survey confirmed chemotherapy and radiotherapy availability nearly 100% of the time. One site reported improved access to radiotherapy while another reported improved access to PET-CT. Barriers to participation included excessive times to obtain regulatory approvals, time constraints and lack of dedicated research staff. Enablers include the simple management algorithm and communication tools. Conclusion: This study demonstrates that multicenter collaboration and harmonization of management protocols are achievable in a middle-income setting. Minimal funding is required but full participation to run high-quality studies requires more financial investment. Focused funding and increased prioritization of research may address systemic barriers to full participation.

Keywords: Adapted treatment regimens; Hodgkin lymphoma; South Africa; harmonization; pediatric oncology.

MeSH terms

Adolescent
Child
Clinical Protocols
Disease-Free Survival
Hodgkin Disease* / drug therapy
Hodgkin Disease* / pathology
Humans
Multicenter Studies as Topic
Positron Emission Tomography Computed Tomography
South Africa