title: Wilms tumor survival in Kenya.
abstract: OBJECTIVE
  Survival from Wilms Tumor (WT) exceeds 90% at 5 years in developed nations, whereas at last report, 2-year event-free survival (EFS) in Kenya reached only 35%. To clarify factors linked to these poor outcomes in Kenya, we established a comprehensive web-based WT registry, comprised of patients from the four primary hospitals treating childhood cancers.
  
  
  METHODS
  WT patients diagnosed between January 2008 and January 2012 were identified. Files were abstracted for demographic characteristics, treatment regimens, and enrollment in the Kenyan National Hospital Insurance Fund (NHIF). Children under 15 years of age having both a primary kidney tumor on imaging and concordant histology consistent with WT were included.
  
  
  RESULTS
  Two-year event-free survival (EFS) was 52.7% for all patients (n=133), although loss to follow up (LTFU) was 50%. For the 33 patients who completed all scheduled standard therapy, 2-year EFS was 94%. Patients enrolled in NHIF tended to complete more standard therapy and had a lower hazard of death (Cox 0.192, p < 0.001).
  
  
  CONCLUSIONS
  Survival of Kenyan WT patients has increased slightly since last report. Notably, WT patients completing all phases of standard therapy experienced 2-year survival approaching the benchmarks of developed nations. Efforts in Kenya should be made to enhance compliance with WT treatment through NHIF enrollment.
authors.affiliation: Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Axt
authors.forename: Fatmah
authors.initials: F
authors.lastname: Abdallah
authors.forename: Meridith
authors.initials: M
authors.lastname: Axt
authors.forename: Jessie
authors.initials: J
authors.lastname: Githanga
authors.forename: Erik
authors.initials: E
authors.lastname: Hansen
authors.forename: Joel
authors.initials: J
authors.lastname: Lessan
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Joyce
authors.initials: J
authors.lastname: Musimbi
authors.forename: Michael
authors.initials: M
authors.lastname: Mwachiro
authors.forename: Mark
authors.initials: M
authors.lastname: Newton
authors.forename: James
authors.initials: J
authors.lastname: Ndung'u
authors.forename: Festis
authors.initials: F
authors.lastname: Njuguna
authors.forename: Ancent
authors.initials: A
authors.lastname: Nzioka
authors.forename: Oliver
authors.initials: O
authors.lastname: Oruko
authors.forename: Kirtika
authors.initials: K
authors.lastname: Patel
authors.forename: Robert
authors.initials: R
authors.lastname: Tenge
authors.forename: Flora
authors.initials: F
authors.lastname: Ukoli
authors.forename: Russel
authors.initials: R
authors.lastname: White
authors.forename: James A
authors.initials: JA
authors.lastname: O'Neill
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
mesh_terms: D000293:Adolescent; D000315:Adrenalectomy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet; D007630:Kenya / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000401:mortality* / Q000473:pathology / Q000628:therapy
keywords: Global health; Kenya; Pediatric cancer; Race disparity; Wilms tumor