Prescribing patterns of antineoplastic agents in paediatric patients at a Tertiary Hospital in Polokwane, Limpopo Province, South Africa

Abstract

Introduction: Over the past decades, childhood cancer mortality rates have declined, yet it remains a leading cause of death among children. Despite well-established cancer treatment modalities, there is limited research on antineoplastic prescribing patterns in paediatric populations. This study examines prescribing patterns for antineoplastic agents in paediatric patients at a tertiary hospital in Limpopo province, South Africa. Objectives: This study aimed to describe prescribing patterns in paediatric oncology by examining the most common cancers diagnosed, the antineoplastic agents employed in their management, and the extent of off‑label prescribing. Methodology: A retrospective, quantitative, cross-sectional study was conducted using medical records of paediatric oncology patients treated at Pietersburg Hospital between 1 January and 31 December 2022. The study included all patients diagnosed with any type of cancer who received at least one antineoplastic agent at the paediatric oncology unit. Data collected encompassed patient demographics, cancer type, prescribed medications, and treatment disposition. Statistical analysis was performed using SPSS version 29.0.0.0, incorporating descriptive statistics, bar charts, and correlation tests. A p-value of ≤ 0.05 was considered statistically significant. Ethical approval was obtained from the Turfloop Research Ethics Committee (TREC) and the Department of Health (DOH), and the study conformed to all relevant ethical rules and guidelines. Results: Childhood cancers were more prevalent in males (56%, n=79) than in females (44%, n=62). The majority of patients were aged 0-4 years (41%, n=58), and most had a healthy BMI/ weight (59.6%, n=84). Solid tumours accounted for 54.6% (n=77) of cases, while haematologic malignancies comprised 45.4% (n=64). Leukaemia was the most common diagnosis (31%, n=44), followed by nephroblastoma (16%, n=23). Vincristine was the most frequently prescribed chemotherapy agent (20.7%, n=557), with Methotrexate following closely (19.6%, n=527). Off-label drug use occurred in 36% of cases, with Cyclophosphamide being the most frequently prescribed off-label agent. No significant associations were identified between patient demographics (age, gender, BMI) and clinical disposition. Conclusion: Cancer prevalence and treatment patterns observed in this study align with global trends, demonstrating consistency with international paediatric oncology practices. The substantial presence of OLU underscores the need for expanded paediatric-specific drug registrations. Furthermore, the absence of correlation between patient demographics and treatment disposition suggests that treatment decisions are primarily driven by disease-specific and therapeutic factors rather than individual patient characteristics.