Browsing by Author "Phipps, Warren"

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    Presentation and Outcomes of Childhood Cancer Patients at Uganda Cancer Institute
    (Global Pediatric Health, 2019-05-18) Mutyaba, Innocent; Wabinga, Henry R.; Orem, Jackson; Casper, Corey; Phipps, Warren
    Limited data suggest that children with cancer in sub-Saharan Africa have poor survival. We aimed to describe the presentation, treatment outcomes, and factors associated with survival among children with cancer managed at Uganda Cancer Institute. Methods. We retrospectively evaluated patients with childhood cancer (age ≤19 years) from Kyadondo County treated at Uganda Cancer Institute from 2006 to 2009. Cox’s regression and Kaplan-Meier methods were used to study 1-year survival. Results. Among 310 patients studied, median age was 7 years (range = 0.25-19 years), 64% were boys, and 92% had histological confirmation of cancer diagnosis. The commonest diagnoses were Burkitt lymphoma (BL, N = 87), Kaposi sarcoma (KS, N = 68), non-BL non-Hodgkin lymphoma (NHL, N = 32), acute lymphoblastic leukemia (ALL, N = 28), Wilms (N = 28), and Hodgkin disease (HD, N = 20). Advanced disease at diagnosis was common for all cancers (ranging from 45% for KS to 83% for non-BL NHL). Overall, 33.2% abandoned treatment. One-year survival was 68% for HD (95% confidence interval [CI] = 11.3-40.6), 67% for KS (95% CI = 52.1-77.9), 55% for BL (95% CI = 42-66.9), 44% for Wilms (95% CI = 22.5-63), 43% for non-BL NHL (95% CI = 23.3-61.3), and 20% for ALL (95% CI = 6.4-38.7). In univariate and multivariate analysis, anemia and thrombocytopenia were associated with mortality for several cancers. Conclusion. Survival among children with cancer in Uganda is poor. Advanced stage disease and loss to follow-up likely contribute to poor outcomes. Anemia and thrombocytopenia may augment traditional staging methods to provide better prognostic factors in Uganda and warrant further evaluation.
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    Soluble Markers of B-Cell Stimulation During Asymptomatic and Symptomatic Malaria Parasitemia in Children in Uganda
    (JCO Global Oncology, 2016-11-10) Mutyaba, Innocent; Byakika-Kibwika, Pauline; Phipps, Warren; Kamya, Moses
    In vitro, Burkitt lymphoma (BL) cell lines express high levels of several cytokines, including CCL3/MIP-1 alpha, CXCL10/IP-10, and IL-10, among others. These cytokines may promote lymphoma development through B- cell hyperstimulation. To understand the influence of malaria infection on cytokine expression in vivo and the potential role in BL development, we sought to characterize the expression of specific cytokines during malaria among children from a region where malaria and BL are endemic. We studied children participating in a prospective malaria cohort in Uganda. Plasma cytokines were assessed in each child at 3 time points representing 3 disease states: no malaria, asymptomatic malaria, and symptomatic malaria. We assessed both equality of cytokine distribution at the 3 time points using Kruskal-Wallis test and the factors associated with cytokine expression using generalized estimating equations. Among the 41 children, median age was 5.0 (0.8-10.3) years when normal, 5.9 (0.8-10.6) years during asymptomatic malaria, and 5.7 (0.5-10.8) years during symptomatic malaria; 39% (16/41) participants were female. There was a significant increase for IL-10 (p<0.001), IL-6 (p=0.04) and IP-10 (p=0.002) during malaria parasitemia compared to no malaria. In the adjusted models, for every one log increase in the parasite density, the odds of high IL10 expression increased by 80% (OR=1.8, 95% CI: 1.3-2.6, P=<0.001), the odds of high IL6 by 30% (OR=1.3, 95% CI: 1.0-1.7, p=0.04), and the odds of high TNFα by 40% (OR=1.4, 95% CI: 1.1-1.8, p=0.01). Younger children (0-4.9 years) had 400% (OR=5, 95% CI=1.7-25, p=0.001) increase in the odds of high IL10 expression compared to older counterparts (5-11 years). Infection with malaria parasites is associated with an immunological response characterized by elevated B-cell stimulatory cytokines including: IL10, IL6, TNFalpha and IP10. These cytokines may mediate B-cell stimulation and related oncogenic DNA changes that lead to BL. Results of EBV viremia are forthcoming.
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    United against cancer: prevention to end-of-life care—highlights from the Uganda Cancer Institute–Palliative Care Association of Uganda Joint International Conference on Cancer and Palliative Care and the 7th Palliative Care Conference, 24–25 August 2017, Kampala, Uganda
    (Ecancermedicalscience, 2017) Downing, Julia; Ddungu, Henry; Kiyange, Fatia; Batuli, Mwazi; Kafeero, James; Kebirungi, Harriet; Kiwanuka, Rose; Mugisha, Noleb; Mwebesa, Eddie; Mwesiga, Mark; Namukwaya, Elizabeth; Niyonzima, Nixon; Phipps, Warren; Orem, Jackson
    The Uganda Cancer Institute (UCI) and the Palliative Care Association of Uganda (PCAU) jointly hosted an international conference oncancer and palliative care in August 2017 in Kampala, Uganda. At the heart of the conference rested a common commitment to see patientcare improved across Uganda and the region. The theme – United Against Cancer: Prevention to End-of-Life Care – reflected this jointvision and the drive to remember that cancer care should include prevention, early diagnosis and screening, treatment, rehabilitation andpalliative care. The conference brought together 451 delegates from 17 countries. The key themes of the conference included: the importanceof the World Health Assembly Resolutions on Palliative Care (2014) and cancer care (2017); the need to develop a National CancerControl Programme; strategies for effective cancer diagnosis and treatment in low- and middle-income countries; advocacy, human rightsand access to essential medicines, including access to opioids and nurse prescribing; paediatric care; leadership and commitment; collaboration;resources (financial and human), the recognition that palliative care is not limited to cancer care and the importance of learningfrom each other. The conference also gave the opportunity to celebrate the 50th Anniversary of the UCI, with a celebration dinner attended by the Minister of Health and the US Ambassador. Participants reported that the conference was a forum that updated them in all aspects of cancer and palliative care, which challenged their knowledge, and was enlightening in terms of current treatment options for individuals with cancer. The benefits of having a joint conference were recognized, allowing for further networking between cancer and palliative care organizations. This conference, highlighting many developments in cancer and palliative care, served as a unique opportunity to bring people together and unite them in developing cancer and palliative care