Treatment abandonment is a major hurdle to improving survival in childhood cancer in the developing world

Ramzan, Mohammed; Yadav, Satya Prakash; Anupam, Sachdeva

doi:10.1002/pbc.24277

Cited by 20 publications

(22 citation statements)

References 4 publications

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“…Abandonment rates of 28-36% have been reported for acute lymphoblastic leukemia (ALL) from developing countries [12,13]. Most patients (64-90%) abandoned therapy within the first month of diagnosis (during remission induction therapy) when none could expect to be cured, and abandonment in general occurs early in treatment or at the time of key therapeutic interventions (e.g.…”

Section: Abandonmentmentioning

confidence: 99%

“…Most patients (64-90%) abandoned therapy within the first month of diagnosis (during remission induction therapy) when none could expect to be cured, and abandonment in general occurs early in treatment or at the time of key therapeutic interventions (e.g. prior to enucleation of the eye for retinoblastoma or amputation of a limb for sarcoma) [12,13]. Reasons for treatment abandonment in India include financial problems, transportation difficulties, beliefs about cancer curability, fear and experience of severe side effects, child refusal (in adolescents), girl child, and dissatisfaction with the treating hospital [12].…”

Section: Abandonmentmentioning

confidence: 99%

“…prior to enucleation of the eye for retinoblastoma or amputation of a limb for sarcoma) [12,13]. Reasons for treatment abandonment in India include financial problems, transportation difficulties, beliefs about cancer curability, fear and experience of severe side effects, child refusal (in adolescents), girl child, and dissatisfaction with the treating hospital [12].…”

Section: Abandonmentmentioning

confidence: 99%

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Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

Yadav

Rastogi

Kharya

et al. 2014

Pediatric Hematology and Oncology

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The survival of children with cancer in India is inferior to that of children in high-income countries. The Indian Pediatric Hematology Oncology Group (IPHOG) held a series of online meetings via www.Cure4kids.org to identify barriers to cure and develop strategies to improve outcomes. Five major hurdles were identified: delayed diagnosis, abandonment, sepsis, lack of co-operative groups, and relapse. Development of regional networks like IPHOG has allowed rapid identification of local causes of treatment failure for children with cancer in India and identification of strategies likely to improve care and outcomes in the participating centers. Next steps will include interventions to raise community awareness of childhood cancer, promote early diagnosis and referral, and reduce abandonment and toxic death at each center. Starting of fellowship programs in pediatric hemato-oncology, short training programs for pediatricians, publishing outcome data, formation of parent and patient support groups, choosing the right and effective treatment protocol, and setting up of bone marrow transplant services are some of the effective steps taken in the last decade, which needs to be supported further.

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Section: Abandonmentmentioning

confidence: 99%

Section: Abandonmentmentioning

confidence: 99%

Section: Abandonmentmentioning

confidence: 99%

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Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

Yadav

Rastogi

Kharya

et al. 2014

Pediatric Hematology and Oncology

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“…2 However, we found very little information on treatment abandonment rates for children with brain tumors in developing countries. 14,15 To our knowledge, our study is the first to report on abandonment of medulloblastoma treatment for children in China. The abandonment rate was 31% in this cohort.…”

Section: Discussionmentioning

confidence: 99%

“…9,14 We investigated the reasons for abandonment by using a questionnaire. The top 3 reasons (preference for alternative medicine, belief that brain tumors are incurable, and confusion regarding the treatment and prognosis of medulloblastoma) were all related to misunderstandings about medulloblastoma and its treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma

Wang¹,

Yuan²,

Jiang

et al. 2016

Journal of Neurosurgery: Pediatrics

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OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients’ median age at diagnosis was 51.96 months (range 3.96–168.24 months). The median duration of follow-up was 32 months (range 3–70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p < 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p < 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases). CONCLUSIONS There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents’ misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.

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Patient tracking during treatment of children with cancer in India – An exploratory study

et al. 2021

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Background: Abandonment of treatment, a major cause of treatment failure in low-and middle-income countries like India, is particularly high during the diagnostic and initial phase of treatment. Tracking of patients during this risk period may reduce treatment abandonment rates and increase quality of care.Aim: The primary aim was to pilot the use and check the acceptability of a tool for tracking children with cancer in New Delhi during the initial part of their treatment.Secondary aim was to estimate abandonment rates among these patients.Methods: This prospective study was carried out in two centers of North India in New Delhi and enrolled children less than 18 years diagnosed with cancer at these centers and who had registered with Cankids for social support. Parent support group (PSG) workers maintained contact with the child's family at least once a week for the first 12 weeks. Details of each contact and subsequent action were recorded in a customized book (called "You are not alone" or YANA Book). Descriptive analysis of these contacts was done in Microsoft Excel and presented in frequencies and percentages. The five-point Likert scale was used to check the acceptability of the tool among the PSG workers.Results: Seven PSG workers enrolled and tracked 81 patients (73% male with a median age of 6 years). During the 12-week study period, 986 contacts were attempted and three (3.7%) patients had abandoned their treatment. All PSG workers strongly agreed that the YANA book was simple to understand and use, decreased their workload, and helped provide better assistance to patients. Conclusion:The tool for patient tracking was well accepted by the PSG workers and considered easy to use. We now plan to implement our model as a routine service at all the partnering hospitals in India.

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Treatment abandonment is a major hurdle to improving survival in childhood cancer in the developing world

Cited by 20 publications

References 4 publications

Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma

Patient tracking during treatment of children with cancer in India – An exploratory study

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