A situational analysis of pediatric cancer diagnostic and research capacity at two childhood cancer treatment centers in Accra, Ghana.

Abstract

e13774 Background: Despite being crucial for effective treatment selection, access to diagnostics in pediatric oncology remains deficient and inequitable in many low- and middle-income countries. As part of pre-implementation planning for the piloting of diagnostic next-generation sequencing (NGS) in Ghana, we assessed baseline diagnostic and research capacity at the only two comprehensive childhood cancer treatment centers in Accra. Methods: Using REDCap, we administered a site assessment survey to senior oncologists at the pediatric oncology units of the Korle Bu Teaching (KBTH) and Greater Accra Regional (GARH) Hospitals. The survey assessed patient volume at each site, and the availability and comprehensiveness of various conventional diagnostics, laboratory equipment, and infrastructure needed to research NGS diagnostic testing. We then conducted a descriptive analysis of the survey data. Results: Annually, an estimated 300 and 36 new pediatric cancer patients are diagnosed at KBTH and GARH, respectively. Leukemias are the most common childhood cancer type, comprising a quarter (25%, n = 75) of new diagnoses at KBTH and nearly half of new cases at GARH (41.7%, (n = 15). Meanwhile, solid tumors make-up 54% (n = 162) of new diagnoses at KBTH and 27.8% (n = 10) at GARH. Morphologic diagnosis is always available at both centers, but other conventional diagnostics, such as flow cytometry, karyotyping, fluorescence in situ hybridization, PCR analysis, microarray testing, and DNA mutation panels are not accessible on-site. Immunohistochemistry is moderately available at KBTH for lymphomas and on a limited basis for solid tumors. Both treatment centers outsource diagnostic testing to private laboratories in Accra and India, specifically flow cytometry for leukemias and immunohistochemistry for lymphomas and solid tumors. The pediatric cancer research capacity for each center includes two part-time research assistants for KBTH and one for GARH, as well as a shared dedicated space for an NGS-based project. Via a research consortium, both centers have access to a research team with an extensive level of experience in DNA / RNA extraction and sequencing, as well as laboratory equipment necessary for NGS, including centrifuges, thermocyclers, DNA/RNA fluorescence-based quantification, and automated electrophoresis. Although not available in the clinical setting in Ghana, Illumina sequencers, namely Nextseq and Novaseq, are available in the research and commercial setting, respectively. Conclusions: The pediatric cancer diagnostic capacity at KBTH and GARH is limited, indicating that treatment for many patients is initiated without the support of essential diagnostics. Nevertheless, the Accra-based treatment centers have adequate research capacity and access to laboratory resources to implement research on diagnostic NGS in the Ghanaian context.