Kenya’s teaching hospital doing well against Wilms tumour

By Gatonye Gathura

Its good news as doctors at Moi referral hospital, dramatically improve survival rates for children with the kidney cancer called Wilms tumour.

The cheerful information shows the hospital to have achieved survival rates of up to 41 per cent from 29 per cent a few years ago.

Still a long way before reaching the about 90 per cent survival rates in developed countries but a recent report shows the doctors could have done better if not for non-medical related problems.

For example, more than a third of children with Wilms tumour at the Moi Teaching and Referral Hospital (MTRH), are abandoning treatment for non-medical reasons.

In a recent study on treatment outcomes of Wilms tumour at MTRH between 2010 and 2012 researchers say the facility could improve on treatment outcomes even further.

The study published in the October issue of the Journal of Global Oncology by researchers from Moi University Eldoret, Vrije University, The Netherlands and Indiana University, US, had investigated treatment outcomes of 39 children with the kidney cancer.

Led by Dr Festus Njuguna of Moi University, the team explains how they are managing to beat the cancer which is the most common kidney tumour in children aged 3 to 4 years.

The hospital, the team explains developed an own treatment manual and set up a multidisciplinary team dedicated to Wilms tumours

“We now have competent pediatric surgeons, psychological counselors, social workers, and pharmacists involved in the care of patients with Wilms tumour.”

Unlike in the past when nurses were moved from one department to another, the report shows the hospital has now dedicated oncology nurses to attend to these children.

This, the report shows to have increased nurses’ knowledge and experience, which has resulted in better patient care.

Working with parents the nurses have broken new grounds. For example, previously the report shows most parents were culturally opposed to the feeding of children with tubes through the nose.

“But this has changed and increasingly improving the nutritional status of the patients which leads to better treatment outcomes,” explains the study.

Responding to evidence which show registration with the National Hospital Insurance Fund (NHIF) improves on cancer treatment the team makes sure their patients are enrolled.

“In the child cancer ward at MTRH, the physicians and nurses now continually inform families about the need for NHIF and make sure they are insured.”

The doctors say there is huge capacity to improve the survival outcomes even further but they also face challenges that are outside their control.

The most common cause of treatment failure in the study was abandonment of treatment which affected more than a third of the patients.

The only children with stage II and III of Wilms tomour, at the hospital who did not survive were those who abandoned treatment.

One of the main reasons families were found to abandon treatment despite proven benefits was distance and cost of transport to and from MTRH.

Patients living 100 km away from the hospital were most likely to abandoned treatment while those who lived within this radius had higher survival rates.

“If this phenomenon is addressed adequately, survival in this group could improve, approaching that reported in high-income countries,” says the study.

The MTRH team is however not celebrating their success yet saying the rates of deaths from Wilms tumours is still unacceptably high.

The second most common cause of treatment failure during the study period they say was death with 23 per cent of children having being lost.

A majority of patients presented at later stages of the disease, 93 per cent between stages III and V, consequently resulting to poor treatment results.

The authors have several suggestion to assist the team achieve the dream of highest survival rates for their patients.

“To help reduce the number of children presenting with late-stage disease we recommend that the government initiate mandatory universal health insurance coverage.”

Establishing satellite clinics and family guesthouses near the hospital, the authors say could help families living far from the hospital.

www.rocketscience.co.ke

Wilms Tumour

Named after Max Wilms a German who wrote about it in 1899

Most common type of kidney cancer in children

Often affects children ages 3 to 4 years

Also known as nephroblastoma

Symptoms

An abdominal mass you can feel

Abdominal swelling

Abdominal pain

Fever

Blood in the urine

Nausea or vomiting or both

Constipation

Loss of appetite

Shortness of breath

High blood pressure

Source: Mayo Clinic

 

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