Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: parents' social network and experiences with hospital retention policies

Mostert, Saskia; Njuguna, Festus; Langat, Sandra; Slot, Annerie; Skiles, Jodi; Sitaresmi, Mei Neni; Ven, Peter M. van de; Musimbi, J.; Vreeman, Rachel C.; Kaspers, Gertjan J. L.

doi:10.1002/pon.3571

Cited by 53 publications

(97 citation statements)

References 24 publications

(51 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Families may avoid coming to the hospital when they are aware of the detention practices. 30,33,34 It may contribute to the lower reported than expected childhood cancer incidence (100-110 children versus 700 children) in the service area of MTRH. 14 In conclusion we found that total delay is much longer than has been reported in most previous studies.…”

mentioning

confidence: 94%

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Njuguna

Martijn

Langat

et al. 2016

Pediatric Hematology and Oncology

Self Cite

View full text Add to dashboard Cite

ABSTRACT. Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment.Study participants were parents of childhood cancer patients diagnosed between August 2013and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days;P < .001).Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

show abstract

mentioning

confidence: 94%

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Njuguna

Martijn

Langat

et al. 2016

Pediatric Hematology and Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Pertinent strategies in LMIC include supporting families to manage the logistics and costs of hospitalization, travel to and from the oncology center, and other common stressors involving needs of other family members at home and lost income when parents must forgo work to remain with the patient. Providers and policy makers must also recognize and help prevent hospital detention practices, where vulnerable patients and even bodies of patients who have died are kept in hospital due to families' inability to pay hospital bills, as reported in Kenya [109].…”

Section: Communication and Decision-making Supportmentioning

confidence: 98%

Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries

Ceppi

Antillón

Pacheco

et al. 2015

Expert Review of Hematology

View full text Add to dashboard Cite

In the last two decades, remarkable progress in the treatment of children with acute lymphoblastic leukemia has been achieved in many low- and middle-income countries (LMIC), but survival rates remain significantly lower than those in high-income countries. Inadequate supportive care and consequent excess mortality from toxicity are important causes of treatment failure for children with acute lymphoblastic leukemia in LMIC. This article summarizes practical supportive care recommendations for healthcare providers practicing in LMIC, starting with core approaches in oncology nursing care, management of tumor lysis syndrome and mediastinal masses, nutritional support, use of blood products for anemia and thrombocytopenia, and palliative care. Prevention and treatment of infectious diseases are described in a parallel paper.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: parents' social network and experiences with hospital retention policies

Cited by 53 publications

References 24 publications

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries

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

Contact Info

Product

Resources

About