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Pediatr Blood Cancer. 2017 Oct;64(10). doi: 10.1002/pbc.26560. Epub 2017 Apr 19.

Improvement in treatment abandonment in pediatric patients with cancer in Guatemala.

Author information

1
Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
2
Stanford University School of Medicine, Palo Alto, California.
3
Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
4
Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California.
5
Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado.
6
Hilo Bay Clinic, Community Health Center, Hilo, Hawaii.
7
School of Health Studies, University of Memphis, Tennessee.
8
Department of Statistics and Biostatistics, Stanford University, Palo Alto, California.

Abstract

BACKGROUND:

Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment.

METHODS:

This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival.

RESULTS:

Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years.

CONCLUSION:

This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.

KEYWORDS:

abandonment; global oncology; low- and middle-income country; pediatric oncology; refusal

PMID:
28423236
DOI:
10.1002/pbc.26560
[Indexed for MEDLINE]

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