Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa.

BACKGROUND: The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS: Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS: We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION: Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.

Predictors of Depressive Symptoms Among Parents of Children With Cancer in Ethiopia.

Background: The severity of the psychological impact on parents of children with cancer, often depressive symptoms due to mild-to-severe stress, is well documented. The causes are primarily related to their child's cancer diagnosis and treatment, side effects, lack of social support, missing information about their child's disease, and understanding of how to care for their child during treatment. This study assessed predictors of depressive symptoms among parents of children with cancer in one hospital in Ethiopia. Method: The institution-based, cross-sectional design was employed. Parents (n = 126) whose child was admitted at Jimma University Medical Center between February 25 and April 25, 2020, and met inclusion criteria were invited to participate. Results: Questionnaires from 122 parents of children with cancer were included (four had missing data). The prevalence of depressive symptoms was 60.7%. Multivariate regression analysis revealed gender (B = 1.207, p = .033) and higher levels of education (B = 1.019, p < .001) were associated with depressive symptoms in mothers. Receiving information about the child's treatment, however, was negatively associated with depressive symptoms (B = -1.490, p = .031). Monthly income and contact with religious leaders were not significant predictors. Discussion: Mothers of children hospitalized for initial cancer treatment in Jimma, Ethiopia, are at risk for depressive symptoms. It is possible that mothers with higher education are in occupations demanding their time, not allowing them to fulfill responsibilities felt to be essential in the child's treatment journey. Information on the child's treatment nurses have an important role in identifying depressive symptoms in parents but require training to do so.

Climate change and oncology nursing: the African perspective.

Climate change is impacting the lives of millions around the world and exacerbating existing challenges in healthcare globally. Although Africa contributes only 2%-3% of global greenhouse gas emissions, it suffers a disproportionate share of the environmental impact. High-income countries dominate the global discourse on climate change, while their continued utilisation of extractive policies exacerbates climate hazards and impacts economies in regions not responsible for the damage. Cancer is on the rise and constitutes a significant public health burden in low- and middle-income countries, yet little is known about the impact of climate change on oncology nursing on the African continent. To address the ways that climate change is exacerbating existing challenges and adding new difficulties for oncology care, it is essential that the expertise of professionals working in settings that are most impacted by the threats of climate change is amplified if climate crisis risks are to be effectively mitigated. Seven African oncology nurses from across sub-Saharan Africa were reflexively interviewed by voice over internet protocol (VOIP) in English to learn about their understanding of climate change and experiences with its impact on nursing care. Using a conceptual framework to map the impact of climate change on health and considering the vulnerability and social capacity of patients with cancer, our findings show how existing challenges to oncology nursing care are exacerbated by climate change on the continent. Food insecurity, national economic dependency on the agricultural sector, economic inequality, social vulnerability and isolation, transportation challenges, and the immunocompromised status of patients with cancer are all key concerns for oncology nurses in this context. We also present the nurses' specific recommendations for governments, hospital authorities, and oncology nurses regarding climate change mitigation, adaptation, and event response strategies. With this work, we aim to lay a foundation for further investigation and action to mitigate the oncoming challenges of climate disaster for oncology nurses across sub-Saharan Africa and the patients and families they care for.

Pediatric Oncology Nursing Research in Low- and Middle-Income Countries: Exemplars from Three Regions.

OBJECTIVE: This study examined the status of pediatric oncology nursing research in three low- and middle-income countries (LMICs) as examples across three World Health Organization regions: East Africa, Eastern Mediterranean region, and Latin America. DATA SOURCES: Published literature was identified from Google Scholar, PubMed, Scielo, Virtual Health Library, and reference lists of some articles. CONCLUSION: The experiences of the three LMIC pediatric oncology nurses illustrate the situation of nurse research in their setting and identify relevant published literature. The authors highlight the challenges for nurses to conduct research (eg, lack of training, mentors, funding, and opportunities). Local evidence to inform nursing practice in LMICs is needed. Recommendations for ameliorating the situation include increased advanced practice nurse education, physician and hospital support, funding, and protected time. IMPLICATIONS FOR NURSING PRACTICE: Pediatric oncology nursing practice is culturally and context-driven and requires locally acquired evidence to support best practices. Only when sufficient, sustainable, and local nursing research training and education is available in LMICs, will this evidence be generated. Nursing research training (eg, master's and PhD programs), funding, and protected time are three key steps to guide and motivate staff nurses as well as academic nurses to participate in research that informs the care of children and adolescents with cancer across all countries and not only those with significant resources.

Predictors of Resilience Among Parents of Children with Cancer: Cross-Sectional Study.

PURPOSE: Resilience is an ability to overcome adversities in response to a potentially traumatic event. It relieves parents' discomfort and builds personal capacity when facing a stressful situation like childhood cancer. Therefore, the study's objective is to assess the magnitude of resilience and its predictors among the parents of children with cancer at Jimma medical center, Ethiopia, 2020. METHODS: The institutional-based cross-sectional design was employed on 126 parents of children with cancer at Jimma Medical Center. All study populations who attend the hospital from February 25 to April 25, 2020, and fulfill the inclusion criteria were included. Data were entered into Epi data version 4.6.0.2 and analyzed by SPSS version 25. Descriptive analysis was used to describe the study variables. Furthermore, linear regression analysis was calculated to assess predictors of resilience. RESULTS: The level of resilience among parents' children with cancer were a mean scored 51.41±12.02. In this study, factors associated with resilience were receiving support from friends (ß=5.67, 95% CI=1.58, 9.77; P=0.007), attend recreational activities (ß=13.8, 95% CI=5.32, 22.37; P=0.03) and receiving health information from health care professionals (ß=6.37; 95% CI= (1.75, 11.00), P=0.007), parents depression (ß= -0.827, 95% CI= (-1.619,-0.034), P=0.041) and parents stress (ß =-0.88,95% CI (-1.54,-0.23), P=0.031). CONCLUSION: The magnitude of resilience among parents of children with cancer was low relative to other studies. Support from friends, attending recreational activities, and receiving health information from health care professionals were positively associated with resilience. In contrast, parents' depression and stress were negatively associated with resilience.