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Type E – Kate Bennett- Differential Survival Rates in State Funded and Privately Funded Paediatric Oncology Units in Johannesburg, South Africa

A travel grant was awarded to Kate Bennett of CMJAH and Wits Donald Gordon Medical Centre to attend the 49th Congress of the International Society of Paediatric Oncology (SIOP) in Washington from 12 to 15 October 2017 to present a poster.

Abstract

Differential Survival Rates in State Funded and Privately Funded Paediatric Oncology Units in Johannesburg, South Africa

Introduction
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.

Methods
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.

Results
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).

Conclusion
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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