Conference abstract
Fever and neutropenia outcomes and areas for intervention: a report from SUCCOUR (Supportive Care for Children with Cancer in Africa)
Pan African Medical Journal - Conference Proceedings. 2023:17(97).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.97.1608
Archived on: 04 Jun 2023
Contact the corresponding author
Keywords: Fever, neutropenia outcomes, areas, children
Oral presentation
Fever and neutropenia outcomes and areas for intervention: a report from SUCCOUR (Supportive Care for Children with Cancer in Africa)
Trijn Israels1, Glenn Mbah Afungchwi2,&, Larissa Klootwijk1, Festus Njuguna3, Peter Hesseling4, Francine Kouya5, Vivian Paintsil6, Lisa Landman1, Inam Chitsike7, George Chagaluka8, Lillian Sung9, Elizabeth Molyneux8
1Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands, 2The University of Bamenda, Bamenda, Cameroon, 3Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya, 4Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa, 5Cameroon Baptist Convention Health Services, Bamenda, Cameroon, 6Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 7Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe, 8Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi, 9Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
&Corresponding author
Introduction: death during paediatric cancer treatment is common in sub-Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention.
Methods: a multicentre prospective, observational cohort study was conducted in sub-Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were abstracted in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented.
Results: a total of 252 patients were included (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109/L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes.
Conclusion: although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment-related mortality.
Fever and neutropenia outcomes and areas for intervention: a report from SUCCOUR (Supportive Care for Children with Cancer in Africa)
Trijn Israels1, Glenn Mbah Afungchwi2,&, Larissa Klootwijk1, Festus Njuguna3, Peter Hesseling4, Francine Kouya5, Vivian Paintsil6, Lisa Landman1, Inam Chitsike7, George Chagaluka8, Lillian Sung9, Elizabeth Molyneux8
1Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands, 2The University of Bamenda, Bamenda, Cameroon, 3Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya, 4Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa, 5Cameroon Baptist Convention Health Services, Bamenda, Cameroon, 6Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 7Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe, 8Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi, 9Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
&Corresponding author
Introduction: death during paediatric cancer treatment is common in sub-Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention.
Methods: a multicentre prospective, observational cohort study was conducted in sub-Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were abstracted in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented.
Results: a total of 252 patients were included (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109/L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes.
Conclusion: although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment-related mortality.
