Background: In 2001, Dr. Sardjito Hospital initiated a systematic hospital-based registry, Yogyakarta Pediatric Cancer Registry (YPCR). This study aims to present an epidemiological profile of childhood malignancies diagnosed in Dr. Sardjito General Hospital and compare it with the previous study 1 Methods: Childhood cancer was diagnosed in children aged 0-18 years, from January 2009 to December 2018, and analyzed. Childhood malignancies were categorized based on age, sex, and disease group according to the International Classification of Childhood Cancer (ICCC-3). An estimated annual average incidence rate (AAIR) of childhood cancer was calculated. We visualized the number of patients and their regions of origin by geographic mapping. Result: There were 1,788 new cases registered in YPCR during the study period. Of these, 58% were male, with a male-to-female.4:1.0. The mean age at diagnosis was 6.3 years old, the median age was 5 years and 56% of cancers were diagnosed in the age group of 0-5 years old. The most common diagnosis category was leukemia (ICCC-3 Category I), which accounted for 60% of all childhood malignancies. The three most common diagnoses included: ALL (44%), AML (13%), and retinoblastoma (6%). Of the 1,077 patients diagnosed with leukemia, 58% were males, most often diagnosed at 0-5 years old (53%). There were 679 patients registered with solid tumors mostly diagnosed at 0-5 years old (57%). The AAIR of leukemia and solid tumors was 26.8 and 17.5 per million, respectively. Conclusion: There was an increase in the number of childhood malignancies in 2009-2018 compared to the 2000-2009 study. The number of patients referred to our hospital increased, indicating a better referral system to the pediatric cancer center. This study is expected to provide data on the hospital-based pediatric cancer registry in Indonesia and promote systematic pediatric cancer registries in other centers.

Background: As in LMICs, the prognosis of childhood ALL in Indonesia was lower than in HICs. Indonesian-ALL2013 protocol resulted in more toxicities and abandonments than expected. Therefore, it was modified into a pilot ALL2016 protocol. Changes to the ALL2013 protocol: no anthracyclines in SR, dexamethasone replaced prednisone in reinduction for HR and some drugs were rescheduled. Procedure: We compare the outcome of ALL2013 and ALL2016. Results: A total of 383 children with ALL were diagnosed, 21 were excluded. ALL2013 included 174 patients (106 SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). The outcome of the ALL2016 was better than the ALL2013 (pOS 67.0% vs 60.3%; p=0.087 and pEFS 50.0% vs 37.9%; p=0.012) even when the number of HR patients was significantly higher in ALL2016 (51.6% vs 39.1%). The ALL2016 showed an early advantage for SR patients (pEFS 56.7% vs 47.2%; p=0.114 and pOS 74.4% vs 69.8%; p=0.298) due to the decrease of toxic deaths (10.4% vs 5.5%; p=0.211) however the number of late relapses were still high (19.5% vs 13.2%; p=0.282). In the HR group, both pEFS and pOS were significantly better in ALL2016 (pEFS 43.3% vs 23.5%; p=0.010 and pOS 59.8% vs 45.6%; p=0.036) due to less relapses (14.4% vs 29.4%; p=0.019). Both SR and HR showed a smaller number of abandonments in ALL2016. Conclusions: After small changes in protocol, initial toxicity and abandonments were reduced and the pOS and pEFS were improved. However, relapses still need to be lessened in the next protocol.

Background Paediatric oncology outreach programs have been effective development interventions to reduce inequalities in healthcare between high-income countries (HIC) versus low and middle-income countries (LMIC). But little is known about its sustainability during times of a pandemic. This study assesses the impact of COVID-19 government measures on a paediatric oncology outreach program between three large referral hospitals in the Netherlands, Indonesia and Kenya. Methods The head from each paediatric oncology outreach partner site was interviewed using a semi-structured questionnaire in June 2021. Results COVID-19 government measures impacted childhood cancer care at all three hospitals. However, disruptions in services are more prominent at partner sites in LMIC, increasing existing inequalities.The doctor from Dutch hospital, located in a HIC, reported only one disruption which is a decrease in surveillance evaluations for patients who completed cancer treatment. The doctors from Indonesian and Kenyan hospitals, located in LMIC, reported multiple disruptions. For example, reduced number of cancer diagnoses, delayed presentations, medical staff shortages, limited availability of chemotherapy and blood products, and delayed or modified treatment administration. Physical interaction between medical teams of all three participating institutions has slowed down. Hereby, adequate transfer of knowledge, skills and expertise have been adversely affected. Conclusion COVID-19 government measures have negatively impacted the intrinsic nature of the paediatric oncology outreach program. Disruptions in childhood cancer care services are more prominent at partner sites in LMIC. Government leaders and policy makers should take collateral damage of their policies and local settings into account to protect children with cancer