Gertjan Kaspers, director of the Máxima Outreach program and recently appointed Knight of the Order of the Dutch Lion, has been very closely involved in numerous Outreach activities since 2008. He talks about the importance of the program that started right after the Máxima opened in 2018: 'The contrast between the cure rate in rich countries like the Netherlands and poorer countries is very big. Whereas in the Netherlands it is 75%, in the poorest countries it is less than 10%.'
'To reduce this large difference, we are working structurally with a growing number of partner hospitals in Kenya, Tanzania, Kosovo, Indonesia and Malawi. In this way, we are also helping to achieve the World Health Organization's goal of bringing the cure rate of the six so-called 'curable cancers' worldwide to 60% by 2030.' To close the gap in cure rates, Professor Kaspers plans to further expand the number of partner hospitals in Sub-Saharan Africa and Indonesia in the coming years. A first step in this was recently taken with the accession of Kenyatta National Hospital (Nairobi, Kenya) and Dr. Hasan Sadikin General Hospital (Bandung, Indonesia).
Increase in chance of curing kidney tumors
Outreach professionals at Máxima collaborate with international organizations including SIOP, the International Society of Pediatric Oncology. Prof. Kaspers says: 'SIOP's Global Health Committee has drawn up a special treatment protocol for Wilms tumors, the type of kidney tumor most commonly found in children, for hospitals with limited (financial) resources. Already several hospitals are following this protocol. So does our partner hospital in Eldoret, Kenya.'
To examine the impact of this treatment protocol, a team of Dutch and Kenyan researchers looked at the cure rates of 92 children with cancer treated at the Moi Teaching and Referral Hospital in Eldoret between 2013 and 2016. The team compared the figures with earlier figures from 2000. They saw an increase in the percentage of children with a kidney tumor who lived two years after diagnosis without their disease recurring from 28.9% in 2000 to 52.2% in 2016. The results of this study were published in the journal Pediatric Blood and Cancer.
In the Netherlands, the cure rate for children with kidney tumors is around 90%. Kaspers: "To achieve a similar cure rate in Kenya, it is important that we get children with (suspected) kidney tumors to the hospital earlier. This requires regional and local training of doctors as well as more awareness about childhood cancer among the entire population. So for kidney tumors, we are definitely on the right track, but there is still much work to be done to close the cure gap. Soon we will evaluate the cure rate for the children who were treated from 2017-2022.'
Earlier and correct diagnosis
'Together with Kenyan, American and Dutch researchers, we examined the data kept by hospitals and linked it to epidemiological data. We saw that in three-quarters of Kenyan children with cancer, they are diagnosed very late or not at all. We therefore investigated the reasons for this in Western Kenya with the same group of researchers. What was found is that although children with symptoms visit a doctor, the diagnosis is not made. After evaluating the knowledge among doctors, it was determined that lack of oncology knowledge is the main reason for this. We therefore continue our efforts to further build knowledge among local healthcare professionals through training sessions and strengthen it through regional cooperation. For example, in the first three years of the Outreach program, some 950 healthcare professionals have been trained, from general practitioners to researchers and social workers. In addition, I hold a visiting professorship at the universities of Yogyakarta and Eldoret. We are also creating more awareness of the subject of childhood cancer through a radio campaign.'
Finding opportunities together for more cures in poorer and richer countries
The collaboration in the twinning programs is not only in the interest of increasing the survival rate of children in poorer countries, but also for scientific research into child cancer. Thanks to the program, Máxima has access to more data and research material, for example tumor tissue. Doctors also learn more about how drugs work in children from different ethnic backgrounds. Ultimately, this additional knowledge will also benefit children with cancer in the Netherlands.