Treatment abandonment in children with cancer in Sub‐Saharan Africa: Systematic literature review and meta‐analysis

Abstract

More data are needed on the extent of treatment abandonment in different countries. Clinicians should encourage parents without insurance to enrol onto the relevant insurance programme straight after diagnosis, provide housing for patients and families close to the treatment centres and to develop treatment at more localized centres.

Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya

“…Due to the retrospective nature of this chart review and incomplete paper records, we were not able to ascertain reasons that eligible patients did not start on chemotherapy. Literature suggests that for other cancers in sub-Saharan Africa affordability [42,43], transportation, and fear, all may contribute to non-initiation [44], but prospective evaluation is needed to understand the differential contributions of these patient-level factors. Similarly, patients' adherence to ART may influence the decision to start chemotherapy therefore should be investigated in future work as well.…”

Treatment abandonment in children with cancer: Does a sex difference exist? A systematic review and meta‐analysis of evidence from low‐ and middle‐income countries

“…At the country level, lower national income, higher reliance on out‐of‐pocket payments and greater economic hardship have been shown to predict higher rates of treatment abandonment 8 . Within communities, parental unemployment, primary level education, absence of health insurance, rural residence and increased travel time to clinic‐based care have each been linked to increased abandonment risk 10,12,14,15 . Together, the available evidence demonstrates marked inequities in childhood cancer treatment access both between and within countries, with the most vulnerable groups at the greatest disadvantage.…”

“…While each captures only those children whose family have sought facility‐based care (ie, the “diagnosed” and “treatment initiated” steps of the care continuum), these data represent a proxy measure of those more likely to both seek care and adhere to treatment recommendations. A number of studies have applied such data to examine factors influencing equity in service uptake and rates of treatment abandonment in childhood cancers generally 7,8,10,28‐41 . Very few studies, however, have specifically examined association between sex and abandonment rates 42 .…”

“…8 Global childhood cancer survival data suggest that the phenomenon of treatment refusal or abandonment-the failure to start or complete medically indicated curative therapy 9 -could account for at least one third of the survival gap between high-income countries and LMICs. 8 Prior estimates indicate that approximately 15% of children aged <15 years newly diagnosed with cancer discontinue treatment worldwide, with 99% of all abandonment cases occurring in LMICs 8,10 where abandonment rates of 35% to 50% have been reported. [11][12][13] At the country level, lower national income, higher reliance on out-of-pocket payments and greater economic hardship have been shown to predict higher rates of treatment abandonment.…”

“…A number of studies have applied such data to examine factors influencing equity in service uptake and rates of treatment abandonment in childhood cancers generally. 7,8,10,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] Very few studies, however, have specifically examined association between sex and abandonment rates. 42 There is a need to fill this evidence gap to guide health system planners in a gender-sensitive approach to the implementation of cancer control programs and ensure that, in the pursuit of universal health coverage, girls with cancer are not left behind.…”