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2015 ; 10
(9
): e0135230
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gab.com Text
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Magnitude of Treatment Abandonment in Childhood Cancer
#MMPMID26422208
Friedrich P
; Lam CG
; Itriago E
; Perez R
; Ribeiro RC
; Arora RS
PLoS One
2015[]; 10
(9
): e0135230
PMID26422208
show ga
BACKGROUND: Treatment abandonment (TxA) is recognized as a leading cause of
treatment failure for children with cancer in low-and-middle-income countries
(LMC). However, its global frequency and burden have remained elusive due to lack
of global data. This study aimed to obtain an estimate using survey and
population data. METHODS: Childhood cancer clinicians (medical oncologists,
surgeons, and radiation therapists), nurses, social workers, and psychologists
involved in care of children with cancer were approached through an online survey
February-May 2012. Incidence and population data were obtained from public
sources. Descriptive, univariable, and multivariable analyses were conducted.
RESULTS: 602 responses from 101 countries were obtained from physicians (84%),
practicing pediatric hematology/oncology (83%) in general or children's hospitals
(79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly
diagnosed with cancer annually in the countries analyzed, abandon therapy.
Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable
to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was
nearly equivalent to the annual number of cancer cases in children <15 years
expected in HIC (26,368). Approximately two thirds of LMC had median TxA ? 6%,
but TxA ? 6% was reported in high- (9%), upper-middle- (41%), lower-middle-
(80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA >
6% were outside the capital. Lower national income category, higher reliance on
out-of-pocket payments, and high prevalence of economic hardship at the center
were independent contextual predictors for TxA ? 6% (p<0.001). Global survival
data available for more developed and less developed regions suggests TxA may
account for at least a third of the survival gap between HIC and LMC. CONCLUSION:
Results show TxA is prevalent (compromising cancer survival for 1 in 7 children
globally), confirm the suspected high burden of TxA in LMC, and illustrate the
negative impact of poverty on its occurrence. The present estimates may appear
small compared to the global burden of child death from malnutrition and
infection (measured in millions). However, absolute numbers suggest the burden of
TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer
in HIC just to TxA, without even considering deaths from disease progression,
relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results
document the importance of monitoring and addressing TxA as part of childhood
cancer outcomes in at-risk settings.
|Adolescent
[MESH]
|Age Factors
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Developing Countries
[MESH]
|Female
[MESH]
|Global Health
[MESH]
|Humans
[MESH]
|Infant
[MESH]
|Infant, Newborn
[MESH]
|Male
[MESH]
|Neoplasms/*epidemiology
[MESH]
|Patient Outcome Assessment
[MESH]
|Population Surveillance
[MESH]
|Refusal to Treat/*statistics & numerical data
[MESH]
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