Improvement in treatment abandonment in pediatric patients with cancer in Guatemala

Elysia Alvarez, Midori Seppa, Silvia Rivas, Lucia Fuentes, Patricia Valverde, Federico Antillón-Klussmann, Mauricio Castellanos, E. Alejandro Sweet-Cordero, Kevin Messacar, John Kurap, Marisol Bustamante, Scott C. Howard, Bradley Efron, Sandra Luna-Fineman

Research output: Contribution to journalArticle

11 Scopus citations

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 languageEnglish (US)
Article numbere26560
JournalPediatric Blood and Cancer
Volume64
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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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

Alvarez, E., Seppa, M., Rivas, S., Fuentes, L., Valverde, P., Antillón-Klussmann, F., Castellanos, M., Sweet-Cordero, E. A., Messacar, K., Kurap, J., Bustamante, M., Howard, S. C., Efron, B., & Luna-Fineman, S. (2017). Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatric Blood and Cancer, 64(10), [e26560]. https://doi.org/10.1002/pbc.26560