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Type E – Dr Kate Bennett – Differential survival rates in state funded and privately funded paediatric oncology units in Johannesburg, SA

A travel grant was awarded to Dr Kate Bennett from Charlotte Maxeke Johannesburg Academic Hospital and Wits Donald Gordon Medical Centre to attend the 49th Congress of the International Society of Paediatric Oncology (SIOP) in Washington from 12th to 15th October 2017.

The major areas of study and how the visit have contributed to the understanding and/or management of cancer

The conference was very big and due to many sessions being run concurrently, I was unable to attend everything. These are the topics that I was able to attend:

  1. Young Investigators Day – How to get involved in research/cancer development; Collaboration and twinning partnerships in research; Mentorship – the importance of having a good mentor; Scientific writing
  2. Educational session on high and low-grade gliomas (brain tumours)
  3. Meet the expert: Embryonal Tumour Board and Sarcoma Tumour Board
  4. Brain tumours: Pseudoprogression in low-grade glioma after radiation; Treatment of young children with PNET or medulloblastoma; Comparison of academic achievement scores after proton and photon therapy
  5. Minimally invasive surgery in Paediatric Oncology
  6. Relapse and relapse detection in Wilms Tumour
  7. Procedural sedation in Paediatric Oncology by non-anesthesiologists
  8. Management of mature B-cell malignancies in Central America
  9. Bone Tumours: Fractures and prognosis of high-grade osteosarcoma; Treatment of localized Ewing Sarcoma of the rib
  10. Nilotinib in CML, Myeloid Sarcoma in children in India; Implementation of Paediatric early warning system in children undergoing stem cell transplants in Latin America; Hepatic Sinusoidal Obstruction Syndrome; Arsenic and ATRA in Acute Promyelocytic Leukaemia
  11. The impact of hearing loss in children treated for cancer. This was an incredible symposium with a lot of impact from parents of children with severe hearing loss post chemotherapy. Prior to this symposium, I did not fully grasp the implications severe hearing loss has on cancer survivors.
  12. PODC session: Infectious complications in HIV positive and negative children with B-cell Non-Hodgkin Lymphomas; Degree of organ dysfunction is predictor of survival in children admitted to the paediatric ICU; Is it safe to administer high dose methotrexate with monitoring methotrexate levels; Clinical impact of isolating respiratory viruses in children with febrile neutropaenia; early deaths in paediatric acute leukaemia
  13. Breast Cancer risk and surveillance in paediatric cancer
  14. Sodium thiosulfate as an otoprotectant in children receiving cisplatinum
  15. Renal tumours: more than just Wilms Tumour: Rhabdoid tumour of the kidney; Clear cell sarcoma of the kidney; Paediatric renal cell carcinoma – this was an excellent session especially as I am currently treating a child with a renal cell carcinoma. This is an incredibly rare tumour with very little literature in the Paediatric age group. It was amazing to attend an entire lecture on this topic and to meet some of the experts in the field.
  16. Soft tissue sarcomas: Intraperitoneal radioimmunotherapy for desmoplastic small round cell tumours; Does early detection with off therapy surveillance imaging improve survival in paediatric rhabdomyosarcoma – this talk made me realise that we need to change how we do post treatment surveillance
  17. New developments in juvenile myelomonocytic leukaemia

Abstract: Differential survival rates in state funded and privately funded paediatric oncology units in Johannesburg, South Africa


Data on survival rates of children with cancer is only available from two South African centres. The reported rate of 52% is far lower than that reported in similar upper-middle income settings in South America and Eastern Europe. The aim of this study was to analyze survival rates of all children with cancer treated in two large referral centres in both the state and private setting.


This retrospective review included all children, (0-15 years) diagnosed with a malignancy at two paediatric oncology units between January 2012 and December 2016. The treatment regimens in both units were identical, the same doctors worked in both settings and all diagnoses were confirmed histologically. Descriptive statistics and Kaplan-Meier analyses with Cox regression modeling are presented.


There were 599 children, 107 of whom presented from outside South Africa. Median follow up was 1.3 years (IQR 0.4 to 2.7). The most common cancers were leukaemias (24.4%), brain tumours (17.7%) and lymphomas (14%). The HIV incidence was 6%. Two-year overall survival was calculated to be 60%. The highest survival rates were in children with Hodgkin Lymphoma, retinoblastoma and nephroblastoma, while the lowest were noted in children with osteogenic sarcoma and neuroblastoma. Children treated at the private institution had higher two-year survival rates than those in the state funded hospital (68% vs 55% p=0.0004).


Two-year overall survival rates were higher for children treated in the privately funded unit. This may reflect differential access to specialist care and earlier referral in the private setting.


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