The Portuguese Pediatric Oncology Centre in support of pediatric cancer patients from Portuguese-speaking African countries: the experience of a decade of a cooperation agreement

Cátia Martins, Pediatric Oncology Centre, Hospital Pediátrico, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
Sónia Silva, Pediatric Oncology Centre, Hospital Pediátrico, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
Filipa Curinha, Pediatric Cardiology Service, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
Mónica Jerónimo, Pediatric Oncology Centre, Hospital Pediátrico, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
Manuel João Brito, Pediatric Oncology Centre, Hospital Pediátrico, Unidade Local de Saúde de Coimbra, Coimbra, Portugal

Introduction and Objectives: Pediatric cancer is a leading cause of non-traumatic death in children over the age of one in high-income countries. However, low- and middle-income countries (LMICs) experience higher incidence and mortality rates due to late diagnoses, treatment abandonment, and inadequate healthcare systems. This study characterizes pediatric cancer patients from Portuguese-speaking African countries (PALOP) treated at a Portuguese Pediatric Oncology Centre (POC) under health cooperation agreements. Methods: Retrospective descriptive study of patients referred to a POC between January 2013 and December 2022. Since 2015, the POC has collaborated with the only National Reference Centre for Onco-Ophthalmology. Results: A total of 43 patients were referred, 65% of whom were male, with a median age of 3.2 years. Most patients came from Guinea-Bissau (34.9%), Cape Verde (32.6%), and Angola (23.3%), with 72.1% evacuated under cooperation agreements. Only 30.2% had initiated treatment in their home country. The median time from symptom onset to the POC consultation was 166 days. Solid tumors were most prevalent (76.7%), especially retinoblastoma (48.8%) and rhabdomyosarcoma (15%). Leukemia accounted for 45.5% of non-retinoblastoma cases. Metastatic disease significantly increased mortality risk (p < 0.001). Recurrence occurred in 23.3%, and 32.6% of patients died. Currently, 58.0% are out of treatment. Discussion: The high prevalence of retinoblastoma reflects the collaboration between the POC and the only National Reference Centre for Onco-Ophthalmology. The overall survival rate of 67.4% was higher than typically observed in LMICs, partly due to the high number of children with retinoblastoma. However, this improved survival rate, emphasizes the need for improved diagnostic and treatment strategies, as well as strengthened international collaboration to enhance pediatric cancer care in resource-limited settings.

Keywords: Neoplasms. Child. Developed countries. Less-developed countries.