Influence of Socioeconomic Status on Childhood Acute Lymphoblastic Leukemia Treatment in Indonesia

Abstract

Children's survival of acute lymphoblastic leukemia in developing countries could improve if problems that are associated with parental financial and educational background and medical teams' attitudes to treatment and follow-up could be addressed better.

Childhood cancer epidemiology in low‐income countries

“…Analysis addresses local problems, such as abandonment of treatment, which is the most common cause of treatment failure in LIC. 23,38 Doctors in Guatemala generate the list of patients to be seen on a particular day and at the end of the day review all visits to make sure that patients who missed appointments can be contacted and encouraged to resume therapy the next day. Social workers store key socioeconomic information that helps determine eligibility for support programs, such as subsidized transportation for clinic visits.…”

“…28,[33][34][35] In some cases adjustment of the chemotherapy regimen will be required to maximize the probability of cure; in all cases, improvements in supportive care and efforts to reduce abandonment will be required. 35 A hospital-based cancer registry and active data management program are essential to successfully monitor outcomes and measure the effect of specific interventions. 36 Such registries must always be developed in the context of a pediatric cancer unit, which serves as the focal point for efforts to improve the quality of care.…”

“…Geographic differences in incidence may suggest unique genetic or environmental exposures that affect cancer risk. In this report we review the inci- Health planning Measurement of the geographic distribution and total number of cases of each cancer type allows planning of the location where pediatric cancer units and satellite clinics should be established and determination of services needed at each site Honduras satellite clinics; development of a regional flow cytometry center 45 Quality improvement Measuring outcomes of treatment and cancer-specific mortality identifies services that need to be improved and facilitates assessment of the efficacy of interventions Development of a pediatric cancer center of excellence in Recife, Brazil 34 Clinical research Adaptation of pediatric oncology treatment regimens Conducting clinical trials of therapy in LIC that use less toxic, less expensive, or otherwise modified versions of published treatment regimens can evaluate the feasibility and outcomes in the local setting ALL and lymphoma in Recife, Brazil, 33,34 Indonesia, 35 and India [46][47][48] Clinical research that can only be performed in LIC Evaluation of clinical problems unique to children with cancer in LIC, including abandonment of therapy, the effects of extreme poverty on compliance and toxicity, and the effects of comorbid illnesses (e.g. malnutrition, parasitic infection) on outcomes can lead to specific mitigation strategies Abandonment risk factors for children with ALL 23,34,35 ; telemedicine in Jordan to improve treatment of central nervous system cancer 49 Comparative clinical research Evaluation of specific aspects of care in diverse settings, such as the effects on outcome of culture, language, socioeconomic status, and other variables that differ greatly between countries…”

Dexamethasone versus Prednisone in Childhood Acute Lymphoblastic Leukemia Treatment: Results of the Indonesian Randomized Trial

“…However, drug-related toxicity was significantly higher with dexamethasone than with prednisone in terms of induction death [8] [11], risk of fractures [12], gastritis and weight gain [13]. With the much higher toxic death rates (17% -23%) reported in low-income countries [14] [15] [16] [17], the toxicity of dexamethasone might prove to be excessive.…”

“…Since 1992, the Indonesian protocols for childhood ALL were dexamethasone based rather than prednisone based [16]. However, because doubts arose about the toxicity of dexamethasone, we conducted a prospective randomized study to evaluate whether the type of steroid used might influence the outcome in our local setting.…”