Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

Mostert, Saskia; Gunawan, Stefanus; Wolters, E.Ch.; Ven, Peter M. van de; Sitaresmi, Mei Neni; Dongen, Jenny van; Veerman, A. J. P.; Mantik, Max F. J.; Kaspers, Gertjan J. L.

doi:10.7314/apjcp.2012.13.12.6491

Cited by 33 publications

(48 citation statements)

References 20 publications

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“…In Malawi, family interviews revealed that absence from home and extra costs during the stay in the hospital were important concerns for parents [40]. Similar findings were noted in a study in Indonesia [39]. In Guatemala, 38% of children abandoned therapy within 6 months; adherence was associated with the presence of electricity, a television, or radio in the home and more than three rooms in the house.…”

Section: Discussionsupporting

confidence: 67%

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Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

et al. 2014

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BackgroundThere exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.MethodsUsing an established database, a retrospective cohort study was conducted of children aged 0–15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.ResultsAmong 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23–0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05–2.58).ConclusionsDespite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.

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Section: Discussionsupporting

confidence: 67%

“…The percentage of patients abandoning treatment in LMIC has been reported in other series to be around 25–50% [31]–[39]. In our cohort, 45% of the patients abandoned treatment.…”

Section: Discussionsupporting

confidence: 59%

Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

et al. 2014

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“…This finding is in line with other studies that examined treatment outcomes for childhood cancer in Indonesia [26, 27]. Although insurance stimulated patients to seek medical help, patients still struggled with direct non-medical costs.…”

Section: Discussionsupporting

confidence: 89%

The role of Indonesian patients’ health behaviors in delaying the diagnosis of nasopharyngeal carcinoma

et al. 2017

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BackgroundWith an estimated 13,000 newly diagnosed patients per year, nasopharyngeal carcinoma (NPC) is one of the most common types of cancer in males in Indonesia. Moreover, most patients are diagnosed at an advanced stage of the disease. This study aimed to explore the health behaviors of patients diagnosed with NPC and the possible causes of patient delay in NPC diagnosis.MethodsA qualitative research method was used to gain better insight into patient behaviors. Twelve patients were interviewed using semi-structured interview guidelines. All interviews were recorded, transcribed verbatim and analyzed according to a standard content analysis framework.ResultsMost patients had limited knowledge regarding NPC and its causes. Fifty percent of the patients had a delay of six months from the onset of symptoms to diagnosis. The main reason for this delay was the lack of awareness among the patients, which was influenced by their environment, economic status, family, culture, and religion. The perceived barriers to seeking medical help included direct non-medical costs not covered by health insurance, complex and time-consuming insurance and referral systems, and negative experiences in the past. Health insurance did motivate people to seek medical help.ConclusionThis study provides additional insight into patients’ motivations to delay seeking medical help and can facilitate the design of NPC education programs. To improve awareness of the abovementioned causes for delay, community-based education programs are highly warranted and should focus on the recognition of NPC symptoms and possible solutions to overcome the main barriers at an earlier disease stage.

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“…Unsurprisingly, wealthier patients generally tend to have better treatment outcomes than financially disadvantaged ones [9]. …”

Section: Introductionmentioning

confidence: 99%

Enhancing the quality of life for palliative care cancer patients in Indonesia through family caregivers: a pilot study of basic skills training

2017

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BackgroundPalliative care in Indonesia is problematic because of cultural and socio-economic factors. Family in Indonesia is an integral part of caregiving process in inpatient and outpatient settings. However, most families are not adequately prepared to deliver basic care for their sick family member. This research is a pilot project aiming to evaluate how basic skills training (BST) given to family caregivers could enhance the quality of life (QoL) of palliative care cancer patients in Indonesia.MethodsThe study is a prospective quantitative with pre and post-test design. Thirty family caregivers of cancer patients were trained in basic skills including showering, washing hair, assisting for fecal and urinary elimination and oral care, as well as feeding at bedside. Patients’ QoL were measured at baseline and 4 weeks after training using EORTC QLQ C30. Hypothesis testing was done using related samples Wilcoxon Signed Rank. A paired t-test and one-way ANOVA were used to check in which subgroups was the intervention more significant.ResultsThe intervention showed a significant change in patients’ global health status/QoL, emotional and social functioning, pain, fatigue, dyspnea, insomnia, appetite loss, constipation and financial hardship of the patients. Male patient’s had a significant effect on global health status (qol) (p = 0.030); female patients had a significant effect on dyspnea (p = 0.050) and constipation (p = 0.038). Younger patients had a significant effect in global health status/QoL (p = 0.002). Patients between 45 and 54 years old had significant effect on financial issue (p = 0.039). Caregivers between 45 and 54 years old had significant effect on patients’ dyspnea (p = 0.031).ConclusionsBasic skills training for family caregivers provided some changes in some aspects of QoL of palliative cancer patients. The intervention showed promises in maintaining the QoL of cancer patients considering socio-economic and cultural challenges in the provision of palliative care in Indonesia.

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Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

Cited by 33 publications

References 20 publications

Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

The role of Indonesian patients’ health behaviors in delaying the diagnosis of nasopharyngeal carcinoma

Enhancing the quality of life for palliative care cancer patients in Indonesia through family caregivers: a pilot study of basic skills training

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