ABSTRACT
Ramandeep Singh AroraBackground Modern-day treatment of childhood cancer is punctuated by the necessary need for intensive care. This study was performed to understand the intensive care unit (ICU) admission rates and factors associated with ICU admission in a cohort of newly diagnosed childhood cancer patients in India. Materials and Methods All childhood (age <18 years) patients in the hospital-based cancer registry who had registered between March 1, 2013, and May 31, 2018, formed the cohort. ICU admissions were recorded and demographic and clinical factors associated with ICU admission were investigated. ICU admission rates were the primary outcome of interest and secondary outcomes were ICU admission rates for sick/supportive reasons, ICU admission rates for surgical/procedural reasons and mortality during ICU admission. Results In a cohort of 258 children (66% males, 61% from India, and median age 7 years), 149 (58%) patients needed one or more ICU admission (median one with range of one to five) with total 204 ICU admission episodes. While age group, gender, and nationality were not significantly associated with ICU admission, cancer type was (highest in neuroblastoma (82%) and central nervous system (CNS) tumors (71%)). Sick/supportive care ICU admissions were significantly higher in patients of younger age, Indian origin, and certain cancers (leukemias, lymphomas). Surgical/procedural ICU admissions were significantly higher in international patients and certain cancers (CNS tumors, neuroblastomas, and soft tissue sarcomas). There were 17 ICU deaths (11% of patients admitted to ICU) and all but one were from sick/supportive care ICU admissions. Conclusion Our study highlights higher than reported ICU admission rates and lower than reported mortality in children with cancer in low- and middle-income countries. We next plan to develop more specific ICU admission criteria, prospectively evaluating severity metrics in these patients, and explore the development of a high dependency unit.
ABSTRACT
OBJECTIVE: Using data from a hospital-based cancer registry (HBCR) in the private sector in Northern India, we provide overall survival (OS) and event-free survival (EFS) for childhood cancer patients. METHODS: All newly diagnosed childhood (age <18 years) cancer patients in our HBCR registered between March 1, 2013 till July 31, 2021 were eligible. 3-year and 5-year OS (death was an event), EFSc (death, progression/relapse was an event), and EFSa (death, progression/relapse, abandonment of treatment was an event) were calculated using the Kaplan-Meier method. Regression analysis was done to see their association with demographic, diagnostic and treatment variables. RESULTS: 705 newly diagnosed children (36.2% female) with cancer were registered. Common cancers were leukemias (26%), CNS tumors (20%) and bone tumors (16%). 202 (28.6%) had experienced an event at median follow up of 1.95 years (range 0-8.14 years), which included 23 (3.3%) who abandoned treatment. The 3-year OS, EFSc, EFSa were 70.8%, 64.4% and 63.6%, respectively. Correspondingly, 5-year OS, EFSc, EFSa were 66%, 58.6% and 57.5%, respectively. There was no significant difference by age group, gender, nationality, and if cancer directed treatment initiated elsewhere. The OS, EFSa and EFSc by the main and the extended International Childhood Cancer Classification categories varied significantly (P<0.001). CONCLUSION: We add more recent registry-based OS data on childhood cancer in India and present the first estimates on EFS.
