Challenges in the Diagnosis and Management of Wilms Tumor in a West Java Tertiary Referral Hospital
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Date
2023-02-20
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Abstract
BACKGROUND: Despite generally promising outcomes for Wilms’ Tumor (WT) patients worldwide, developing countries such as Indonesia still struggle with poor survival rate due to many influencing factors. This study aims to evaluate challenges in diagnosing and treating WT patients in a third level referral hospital located in Bandung, West Java, over the last 5 years.
METHODS: A cross-sectional observational study was performed using medical records of children (0–18 years old) that underwent Wilms’ Tumor treatment at Dr. Hasan Sadikin General Hospital (RSHS) over a 5 year period (January 2018–December 2022) in which the following data were collected: patient demographic, presenting and diagnostic features, clinical characteristics, treatment choice and outcome.
RESULTS: Forty patients that were deemed eligible for this study ranged in age 2 months–15 years on diagnosis with a median age of 3.4 years. Abdominal mass was the most common presenting complaint (95%). Six patients (15%) underwent upfront nephrectomy and adjuvant chemotherapy, 18 patients (45%) had post-chemotherapy nephrectomy, while 16 (40%) were administered neoadjuvant chemotherapy without ever receiving operation. Through IP-CAR system, we identified the time it took 31 patients to visit a medical facility after first complaint (median 88 days), admission to RSHS for cancer treatment after first medical visit (46 days), and administration of chemotherapy after WT diagnosis was established (49 days).
CONCLUSION: Results of our study indicates there are still many major challenges in managing WT patients such as advanced disease presentation, delays in management, and nonuniformity of diagnosis and treatment protocol.
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Wilms Tumor (WT), Nephroblastoma, Diagnosis