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.
| Original language | English (US) |
|---|---|
| Article number | e26560 |
| Journal | Pediatric Blood and Cancer |
| Volume | 64 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2017 |
| Externally published | Yes |
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Keywords
- abandonment
- global oncology
- low- and middle-income country
- pediatric oncology
- refusal
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Hematology
- Oncology
Cite this
Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. / Alvarez, Elysia; Seppa, Midori; Rivas, Silvia; Fuentes, Lucia; Valverde, Patricia; Antillón-Klussmann, Federico; Castellanos, Mauricio; Sweet-Cordero, E. Alejandro; Messacar, Kevin; Kurap, John; Bustamante, Marisol; Howard, Scott C.; Efron, Bradley; Luna-Fineman, Sandra.
In: Pediatric Blood and Cancer, Vol. 64, No. 10, e26560, 01.10.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Improvement in treatment abandonment in pediatric patients with cancer in Guatemala
AU - Alvarez, Elysia
AU - Seppa, Midori
AU - Rivas, Silvia
AU - Fuentes, Lucia
AU - Valverde, Patricia
AU - Antillón-Klussmann, Federico
AU - Castellanos, Mauricio
AU - Sweet-Cordero, E. Alejandro
AU - Messacar, Kevin
AU - Kurap, John
AU - Bustamante, Marisol
AU - Howard, Scott C.
AU - Efron, Bradley
AU - Luna-Fineman, Sandra
PY - 2017/10/1
Y1 - 2017/10/1
N2 - 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.
AB - 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.
KW - abandonment
KW - global oncology
KW - low- and middle-income country
KW - pediatric oncology
KW - refusal
UR - http://www.scopus.com/inward/record.url?scp=85018591373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018591373&partnerID=8YFLogxK
U2 - 10.1002/pbc.26560
DO - 10.1002/pbc.26560
M3 - Article
C2 - 28423236
AN - SCOPUS:85018591373
VL - 64
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
SN - 1545-5009
IS - 10
M1 - e26560
ER -