review · ecancermedicalscience
Paediatric cancer survival in low- and middle-income nations remains poor due to late diagnosis, limited supportive care, and treatment abandonment. To address this, healthcare centres in Cameroon and collaborating sub-Saharan African institutions have adopted modified treatment protocols tailored to resource-constrained environments. A systematic review and meta-analysis of twelve studies published over two decades, covering 1,984 young patients, evaluated the survival impact of these adapted regimens. Most frameworks were derived from international paediatric oncology guidelines. The analysis revealed marked clinical and methodological heterogeneity across the studies. While the adapted protocols supported encouraging survival outcomes, the most prominent and consistent driver of success was early diagnosis. Children diagnosed at earlier stages had nearly six times better odds of favourable outcomes compared to those with advanced disease. Direct comparisons between specific protocols showed smaller and less consistent differences, highlighting the fundamental importance of timely detection.
Childhood cancer survival in resource-constrained regions lags significantly behind outcomes in high-income countries. This synthesis demonstrates that while tailoring chemotherapy and care protocols to local capacities is encouraging, medical interventions alone cannot overcome late presentation. Health systems and funders must prioritise early cancer detection, community screening, and timely referral pathways to achieve meaningful improvements in survival for young patients across sub-Saharan Africa.
The abstract does not indicate a commercial application pathway. The findings primarily offer clinical and operational evidence to guide healthcare authorities, hospital networks, and non-profit organisations in designing early detection initiatives and standardising paediatric oncology care protocols in resource-limited settings.
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Survival outcomes for childhood cancers remain substantially lower in low-and middle-income countries than in high-income countries, largely due to late diagnosis, limited supportive care and treatment abandonment.In response to these challenges, Cameroon and collaborating Sub-Saharan African centres have implemented adapted paediatric cancer treatment protocols designed to balance effectiveness with feasibility in resource-constrained settings.Yet, the survival impact of these adaptations has not been systematically synthesised.We conducted a systematic review of studies published over the past 20 years that reported treatment protocols and survival outcomes among children and adolescents with cancer in Cameroon or in multicentre African studies that included Cameroonian patients.Searches were run in PubMed, Google Scholar, African Journals Online and grey literature sources.Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Anal 2020 guidelines, and risk of bias was assessed using ROBINS-I.A random-effects meta-analysis was used, given the expected clinical and methodological heterogeneity.Twelve studies, including 1,984 participants, were included; four were conducted only in Cameroon, and eight were multicentre African studies including Cameroon.Most protocols were adapted from the International Society of Paediatric Oncology and Groupe Franco-Africain d'Oncologie Pédiatrique guidelines.Because studies differed in reported outcomes, study design and comparator structure, comparative odds ratios (ORs) were pooled for exploratory purposes only and were not interpreted as a single causal measure of protocol effectiveness.An initial random-effects model showed substantial heterogeneity (I 2 = 85%).The strongest and most consistent pattern was seen in stage-based comparisons, where children diagnosed earlier had much better outcomes than those presenting with advanced disease (pooled OR 5.89, 95% CI 3.38-10.29).By contrast, implementation/time-based comparisons and protocol-versus-protocol comparisons were smaller and less stable in sensitivity analysis.Overall, adapted protocols appear to support encouraging outcomes, but the clearest advantage was linked to earlier diagnosis rather than to a uniform protocol effect.More standardised outcome reporting and stronger prospective studies are needed.
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DOI: 10.3332/ecancer.2026.2193
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