1. Pediatric Oncology Care in Tanzania:
The Challenges Faced and a Vision for the Future
By: Liz Danik, RN, BSN, CPHON

2. Common Pediatric Cancers seen at KCMC
Retinoblastoma
Burkitt Lymphoma
Wilms Tumor
Rhabdomyosarcoma
Acute Lymphoblastic Leukemia (ALL)
Osteosarcoma
Neuroblastoma

3. Challenges in treating pediatric cancers at KCMC
Care is often delayed or misdiagnosed; therefore, children are coming in with late stage cancer.
In a study done in S.Africa, over 80% of patients with BL presented with Stage III/IV, with an overall survival rate of 64.7% (compared to 80% in HIC) (Stefan & Lutchman, 2014)
Cancer treatment is expensive and many cannot afford to pay for treatment, transportation, or lodging.
Average cost for treatment is around $200; however, most families make less than $500/year. (Duke Cancer Institute, 2016).
Since so many children are too advanced to be treated, palliative care is often the only option. It can be a challenge to adequately treat children with palliative care.
In LMIC countries, survival rates are less than 30% for pediatric cancers (compared to 80% in HIC). (Duke Cancer Institute, 2016)

4. Challenges related to Nursing Care
Limited knowledge of pediatric cancer diagnoses, chemotherapies, safe handling of chemo, and providing supportive care.
No protocols on how to handle oncologic emergencies, such as: Fever/Neutropenia, Tumor Lysis Syndrome, Pain, Septic Shock, etc.
Facilities do not allow for staff to have adequate infection control: limited access to sinks and hand sanitizers for hand washing, no isolation areas for patients with infectious symptoms.
Little to no training and support in dealing with psychosocial aspect of pediatric oncology care.

5. My contributions to the KCMC Cancer Center
1 week was spent in Dar es Salaam at Muhimbili Hospital with Dr. Trish Scanlan
Shadowed nurses and other caregivers on the oncology unit
Experienced the progression of a patient from the ward to the ICU and the challenges faced
Obtained examples of forms, protocols, and resources used for staff
Education and Training for Nurses at KCMC:
Nursing Care for pediatric oncology patients- presentation done for all nurses at KCMC
Safe Chemotherapy Administration
Created new chemo protocol forms, handouts, and nursing resource binder

6. My contributions to the KCMC Cancer Center

9. Vision for Pediatric Oncology at KCMC
Education:
Build a pediatric oncology curriculum for nurses
Provide continuing education for nurses r/t diagnoses, treatments, and chemotherapy handling
Establish an orientation, competency check off, and skills verifications for all new nurses at the Cancer Center
Certification program for nurses, and mentorship program
Development:
Protocol development addressing pediatric oncology care: fever/neutropenia, pain, sepsis, etc
Review Standards of Practice for chemo administration, safe handling, and infection control
Support:
Provide training and support to staff re: difficult conversations, end of life talks, etc.
Provide mentorship, and resiliency opportunities for staff

10. Questions, Comments?
Asante Sana!

11. References:
Duke Cancer Institute website (2016). “A Small Price to Pay.”.
James, S. (2015). “Meeting the Challenge of Cancer Care in Northern Tanzania.” A Program for Comprehensive and Sustainable Care.
Stefan, D. & Lutchman, R. (2014). “Burkitt lymphoma: epidemiological features and survival in a South African centre.” Infectious Agents and Cancer :19.