Treatment abandonment: A report from the collaborative African network for childhood cancer care and research—CANCaRe Africa

Abstract

Background: 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low-and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. Methods: A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. Results:We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). Conclusions: Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.

Outcomes of a resource-adapted Wilms tumor treatment protocol in Lilongwe, Malawi, 2016-2021: successes and enduring barriers to cure

“…9,25,26 A recent review of allcancer abandonment across five African pediatric cancer centers reported that contemporary rates remain consistently above 10%. 27 While high OS among low-stage disease reflects progress within the setting of the cancer center, EFS reflects the true burden of mortality within our cohort due to abandonment. For example, OS for stage I/II disease was 71%, but EFS was reduced to 54% due primarily to abandonment.…”

“…9,25,26 A recent review of all-cancer abandonment across five African pediatric cancer centers reported that contemporary rates remain consistently above 10%. 27…”

“…Treatment abandonment is a multifaceted phenomenon caused by complex structural and socioeconomic barriers that are often beyond the control of providers and families. 27,[29][30][31][32] Financial pressures are common and include unaffordable therapy, absent transportation, and loss of parental income. Developing strategies to improve retention is a top priority among providers and organizations working in sub-Saharan Africa.…”

“…For example, regional networks such as the Collaborative African Network for Childhood Cancer and Research have decreased treatment abandonment and improved outcomes for Wilms tumor through follow-up programs, robust contact networks, and direct financial support to families. 27,33 While our center implements an active follow-up system and utilizes financial support to families, a large catchment area with travel time to the cancer center routinely >12 hours may have contributed to our high rate of abandonment, as well as incompletely addressing the financial impact of therapy for an extremely resourcelimited population. Further study into implementation strategies that are generalizable to the heterogenous array of logistical and financial challenges facing cancer centers in LMICs are essential.…”

Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage

“…115 The Collaborative has added a supportive care clinical research program, Supportive Care for Children with Cancer in Africa, as part of the larger Collaborative African Network of Clinical Care and Research for Childhood Cancer (CANCaRe Africa) to investigate treatment abandonment and develop locally-appropriate treatment guidelines. [116][117][118] Barriers to childhood cancer treatment across Africa include late clinical presentation, lack of access to specialty pediatric oncology care, treatment abandonment, lack of supportive care, and lack of access to clinical trials. 99 However, local leadership, design of resource-conscious adapted treatment regimens, and prioritization of stepwise infrastructure building, as accomplished by GFAOP and others and as advocated by the CureAll framework, have already resulted in improved childhood cancer survival.…”