# Global initiative for childhood six-indexed cancers: how are we faring in Nigeria?

## TL;DR

This study examines the status of six childhood cancers in Nigeria, finding high mortality and treatment abandonment rates, and highlights the need for improved healthcare access and education to meet global survival goals.

## Contribution

The study provides the first nationally representative data on GICC-indexed cancers in Nigeria, identifying critical barriers to treatment and outcomes.

## Key findings

- Acute lymphoblastic leukaemia was the most common GICC-indexed cancer in Nigerian children.
- Treatment abandonment and mortality rates were high, with infection and haemorrhage being leading causes of treatment-related deaths.
- Only 7% of children with advanced-stage Wilms tumour and retinoblastoma received radiotherapy due to financial and access barriers.

## Abstract

WHO's Global Initiative for Childhood Cancer (GICC) aims to increase global survival of childhood cancers to 60% by the year 2030 with a focus on six index cancers. However, there is no nationally representative epidemiologic data on these index cancers in Nigeria.

To describe the distribution, outcomes and determinants of GICC six-indexed cancer in Nigeria.

A multi-centre ambi-directional cohort study of children was done in children <19 years diagnosed with any of acute lymphoblastic leukaemia (ALL), Wilms tumour (WT), retinoblastoma (RB), Hodgkin lymphoma (HL), Burkitt lymphoma (BL) or low-grade glioma (LGG). Seven centres in the six geopolitical zones of the country participated. A 2-year study with 18 months of retrospective data collection (January 2022–June 2023) and follow up of subjects was done for 6 months (July–December 2023).

A total number of 213 subjects were enrolled and ALL (n = 72;33.8%), WT (n = 57; 26.8%), RB (n = 52; 24.4%), BL (n = 17; 8.0%), HL (n = 13; 6.1%) and LGG (n = 2; 0.9%) accounted for the disease pattern. Median age at diagnosis was 5 years (51.6%). Mortality rate was 32.4% and treatment abandonment occurred in 37.6% of subjects. Treatment-related mortalities (TRMs) were 37.7% with infection and haemorrhage the commonest specific causes of TRM (36.1% and 42.5%). Only 7/95 (7%) of subjects with WT and RB stage III and IV benefited from RT. The most common reasons for non-RT were lack of funds (29%), lack of access to RT (54%) and lack of physicians’ referral (11%). Only 10 (4.3%) of subjects were enrolled in a health insurance scheme. Independent risk factor for mortality was advanced disease stage (p = <0.001). Amongst the mortalities, 36% died within the first 3 months of diagnosis.

Treatment abandonment, mortality and TRM are high in Nigeria. To attain the GICC goal, there is a need to educate physician on treatment protocol, ensure availability of supportive care, health insurance, RT and tackle late presentation.