Title : Prescribing and treatment patterns of childhood cancers at a tertiary hospital in Limpopo province, South Africa
Abstract:
Despite a 70% decline in childhood cancer death rates between 1970 and 2020, cancer remains the leading disease-related cause of death in children. While cancer treatment modalities are well understood, chemotherapy prescribing patterns in South Africa are not standardized. This study investigated the prescribing trends of antineoplastic agents in a paediatric oncology unit at a tertiary hospital in Limpopo Province, South Africa. Using a retrospective, quantitative, cross-sectional approach, medical records of paediatric oncology patients treated in 2022 were analysed. Patients included were diagnosed with any cancer type and prescribed at least one antineoplastic agent. Data collection involved demographic details, cancer type, prescribed drugs, and treatment outcomes, analysed using SPSS version 29. Out of 158 paediatric patients, 141 met the inclusion criteria (62 females, 79 males), ranging from 3 months to 15 years. The majority were in the 0–5 years age group. The most common cancers were haematologic malignancies (54%) and solid tumours (51.8%). Leukaemia was the most prevalent cancer (32%), with acute lymphoblastic leukaemia (ALL) comprising 82.2% of leukaemia cases. Among solid tumours, blastomas were most frequent (71.1%), including nephroblastoma (42.6%), retinoblastoma (22.2%), and rhabdomyosarcoma (55.5% of sarcomas). By the end of 2022, 72 patients remained in treatment, 26 had died, 6 were lost to treatment, 3 were transferred, and 17 had completed chemotherapy. Of 2,689 prescriptions, Vincristine (20.71%), Methotrexate (19.6%), and Cyclophosphamide (8.41%) were the most frequently prescribed drugs. While 58.42% of prescriptions were approved by the South African Health Products Regulatory Authority (SAHPRA), 36.07% were off-label (OLU). Off-label events included drugs with unverified safety and efficacy in children (18.52%), drugs not approved for paediatric use in South Africa (10.15%), and drugs not registered for specific cancer types (6.84%). Despite the approvals, 85.8% of patients received at least one off-label antineoplastic agent. This study highlights significant reliance on off-label chemotherapy in paediatric oncology, underscoring the need for standardised treatment guidelines to ensure safe and effective treatment.
Audience Take Away Notes:
1. Key Learnings for the Audience
- Understanding the prescribing patterns of antineoplastic agents in paediatric oncology in South Africa.
- Awareness of the extent and implications of off-label drug use (OLU) in paediatric cancer treatment.
- Insights into the challenges of standardizing chemotherapy protocols in a resource-limited setting.
- The importance of regulatory approvals and how off-label prescribing affects patient outcomes.
2. Practical Applications for the Audience
- Healthcare professionals can use the findings to advocate for clearer treatment guidelines and safer use for paediatric cancer patients.
- Medical policymakers can leverage the study to push for better regulatory frameworks and drug approvals for paediatric oncology treatments.
- Researchers can use the data to further investigate the impact of off-label drug use on treatment success rates and adverse effects.
3. Impact on the Audience’s Job
- Oncologists & Pharmacists: The study provides crucial insights into current prescribing patterns and highlights areas where safer, more effective drug choices could be made.
- Medical Educators: This research can be integrated into training programs to inform students about real- world challenges in paediatric cancer treatment.
- Hospital Administrators: The findings can guide better resource allocation, ensuring that approved and effective drugs are prioritized in treatment protocols.
4. Contribution to Faculty Research & Teaching
- Faculty members in pharmacy, medicine, and public health can use the study as a case example in pharmacology, oncology, and health policy courses.
- The research can serve as a foundation for further studies on the safety and effectiveness of off- label drug use in paediatrics.
5. Practical Solutions & Efficiency Gains
- The study underscores the need for a standardized chemotherapy protocol, which can reduce variability in treatment and improve patient outcomes.
- It highlights gaps in regulatory approvals, enabling hospitals and government agencies to push for better pediatric oncology drug approvals.
- The data can guide the development of treatment algorithms that simplify oncologists' decision- making and improve patient safety.
6. Impact on Accuracy & Design Problems
- By identifying the most commonly prescribed chemotherapy drugs, the study helps streamline drug selection and dosage accuracy.
- Hospitals can use these findings to refine treatment protocols, ensuring that medications are used more effectively and safely.
7. Additional Benefits
- Raises awareness about paediatric oncology drug accessibility and safety in South Africa.
- Provides baseline data for further clinical and policy-related research.
- Encourages collaboration between clinicians, researchers, and policymakers to improve paediatric cancer treatment.
- May influence future drug trials and regulatory updates to expand treatment options for children with cancer.
- This research is a stepping stone toward better, evidence-based chemotherapy protocols, ultimately leading to improved survival rates and quality of life for paediatric cancer patients.
