Tracking children with acute lymphoblastic leukemia who abandoned therapy: Experience, challenges, parental perspectives, and impact of treatment subsidies and intensified counseling (original) (raw)
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Treatment abandonment in pediatric patients with acute lymphoblastic leukemia
Boletín médico del Hospital Infantil de México
background.Treatment abandonment is at the end of the spectrum of noncompliance. In children with cancer, whatever the cause that leads to treatment abandonment results in disease progression, recurrence and death. Therefore, the purpose of this study was to determine the frequency of treatment abandonment in pediatric patients with acute lymphoblastic leukemia (ALL) affiliated with the Seguro Popular insurance program. methods. We conducted a systematic review of the literature on the frequency of ALL abandonment and a retrospective cohort study of clinical files of ALL pediatric patients diagnosed during 2001 to 2003 and 2007 to 2009 in seven Mexican states. Results. A review of the literature shows that, among pediatric patients with ALL, treatment abandonment is seen almost only in developing countries and the documented rates may be as high as 64%, but with a diminishing tendency. The abandonment rate for children affiliated with the Seguro Popular insurance program was 13.3% during 2007 to 2009. In contrast, there was a rate of 21.4% of patients who abandoned before their implementation. The highest rates of treatment abandonment were observed during early treatment stages and were seen in hospitals from the states of Hidalgo and Puebla. Conclusions. In comparison to other developing countries, a lower rate of treatment abandonment has been seen in pediatric patients with ALL affiliated with the Seguro Popular insurance program. This observation would be related to the social and economic support provided by this program; however, the rate of abandonment is still high, making it necessary to introduce additional actions in order to improve this issue.
2017
Background: In developing countries, refusal and abandonment is the main challenge regarding treatment of Acute Lymphoblastic Leukemia (ALL). This study tried to understand and find out the causes of treatment refusal and abandonment in Bangladeshi children with ALL. Methods: Over 3 years in Dhaka Shishu (Children) Hospital, all diagnosed children with ALL (12 month to 16 year) were included in this prospective study. Open interviews were conducted with the parents who refused or abandoned treatment about their financial and educational status and causes of refusal or abandonment. This study analyzed the situations from the parental point-of-view. Chisquare test (for parental economic status) was used for statistical analysis. P value less than 0.05 was considered as statistically significant. Results: Thirty three percent parents refused to take and 20% abandoned the treatment. Both were significantly high in children whose parents’ financial and educational background was low. Pre...
Childhood acute lymphoblastic leukemia: refusal and abandonmentof treatment in the southeast of Iran
TURKISH JOURNAL OF MEDICAL SCIENCES, 2016
Background/aim: Acute lymphoblastic leukemia (ALL) accounts for 25% of all malignancies in children. ALL treatment has standard protocols, and treatment abandonment is a main cause of treatment failure. Therefore, this study aimed to assess the relationship between socioeconomic status and rate as well as cause of abandoned treatment in children with ALL in the southeast of Iran. Materials and methods: This retrospective, descriptive cohort study was conducted with ALL patients at the Ali Asghar Hospital in the city of Zahedan. The study population included 22 children with different subtypes of ALL who had abandoned their treatment. A structural questionnaire was filled out by patients or their parents. Results were assessed using descriptive and analytical tests. Results: The rate of treatment abandonment was 24.4% (22 patients).We had 18 ALL-L1 (78.3%) and four ALL-L2 (17.4%) patients. Reasons for treatment abandonment were low family income, transportation difficulties, the father's education status, conviction about ALL's incurability, and reference to spiritual means, respectively. Conclusion: Low family income, transportation difficulties, the father's education status, belief about ALL's incurability, and reference to spiritual means were the most common associations with ALL treatment abandonment in that order. Financial problems in this part of the country can impose high costs to the healthcare system.
Indian Journal of Medical and Paediatric Oncology
Aim: One of the causes for lower cure rates in acute childhood leukemia in low-and middle-income countries (LMIC) compared to high-income countries is abandonment from treatment. The International Society of Pediatric Oncology (SIOP) defines abandonment as failure to begin treatment or an absence of 4 weeks during treatment. The aim of this study was to evaluate the extent of abandonment among patients diagnosed with acute myeloid leukemia (AML) at the pediatric ward at a low-resource cancer center in India. Methods: Medical records of all patients, aged 0-15 years, diagnosed with AML between January 1, 2014, and March 31, 2015, at the hospital were reviewed. Age, sex, date of diagnosis, and survival during the short follow-up time after completed treatment and information regarding abandonment were collected. SIOP definition of abandonment was used. Eight patients were diagnosed with AML at the hospital whereof 65 met the inclusion criteria of this study. Results: Of the included 65 patients, 6 died before treatment could be initiated and 3 were referred to palliative care upfront. Thus, 56 patients were offered curatively intended treatment. Of these patients, six refused treatment at this stage and another five abandoned during therapy. Altogether, 11 children abandoned treatment. Conclusion: In this study, the abandonment rate from treatment of childhood AML was 20%, which is in concordance from other studies conducted in India and other LMIC, stating that abandonment is a problem and hindrance when treating with a curative intent.
Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2017
Lymphoma is the commonest pediatric cancer in sub-Saharan Africa (SSA). Frequent treatment abandonment contributes to suboptimal outcomes. We examined risk factors and reasons for treatment abandonment for this population in Malawi. We conducted a mixed methods study among children < 18 years old with newly diagnosed lymphoma, prospectively enrolled during 2013-2016. All children received standardized diagnosis and treatment, and were followed for up to 2 years. Treatment abandonment was defined as failure to attend prescribed chemotherapy within 4 weeks, or post-treatment visit within 3 months. Child, guardian, and household characteristics associated with treatment abandonment were assessed. Semi-structured interviews were conducted with primary caregivers of children experiencing treatment abandonment. Of 121 children with newly diagnosed lymphoma, 72 (60%) had complete information regarding child, guardian, and household characteristics. Of these, 56 (78%) had Burkitt's a...
Socioeconomic factors for abandoning medical treatment by pediatric patients with acute leukemia
El objetivo del presente estudio fue describir la frecuencia de abandono del tratamiento médico por leucemia aguda por pacientes pediátricos sobre la base de características psicosociales y estadio de la enfermedad. Para ello, se revisaron 134 expedientes clínicos de aquellos pacientes atendidos a lo largo de cinco años. Los resultados muestran un índice de abandono de casi una cuarta parte. El nivel socioeconómico resultó significativo para dicho abandono del tratamiento, siendo la pobreza el principal factor. Sin embargo, se constató que una considerable mayoría de los pacientes en pobreza extrema recibían algún tipo de apoyo económico, lo que sugiere que el abandono del tratamiento médico se debe a procesos cognitivos y emocionales que los propios pacientes y sus familias experimentan ante la enfermedad. Se destaca la importancia de la intervención psicológica, así como la necesidad de llevar a cabo investigaciones adicionales que analicen dichos procesos.
Abandonment and Outcome of Induction Chemotherapy in Childhood Acute Lymphoblastic Leukemia
Research In Cancer and Tumor, 2021
Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. It constitutes approximately 31% of cancers in children below 15 years of age and approximately 77% of all cases of childhood leukemia. Abandonment is one of the most important causes of treatment failure in ALL in developing countries. Objective: To determine the percentage of abandonment and outcome of induction chemotherapy among children with acute lymphoblastic leukemia (ALL). Methodology: This prospective, observational study was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of 2 years from 1 st July 2014 to 30 th June 2016. After admission thorough, physical examination of suspected ALL patients was done meticulously. If clinical features and blood picture suggested leukemia, then bone marrow aspiration was done to confirm the diagnosis. A total 33 diagnosed ALL patients were selected as per inclusion and exclusion criteria. Modified UK-ALL 2003 induction protocol, regimen-A was given for 13 patients and regimen-B was given for 9 patients, remission was assessed by doing morphology of bone marrow aspiration at day 29. Those who refused to start induction chemotherapy or not completed induction chemotherapy was categorized as abandonment and reasons for abandonment were identified through appropriate questioning and discussion. Remission rate was considered as primary outcome. Results: Among recruited 33 ALL patients in this study 18 (54.5%) patients were male and 15 (45.5%) female. Mean ± SD age was 5.28 ± 3.42 years with age range 15 months to 12 years. Out of 33 patient's cumulative treatment abandonment before and during induction were 14 (42.42%), cumulative death before and during induction 5 (15.16%), 14 (42.42%) patients completed induction among them 12 (85.7%) patients achieved remission and continued treatment, 2 (14.3%) patients fails to achieve bone marrow remission. Most important cause of abandonment was that they can't afford to treat. Conclusion: There was high abandonment and treatment related mortality; however, majority of the patients who continued treatment achieved remission at the end of induction.
Journal of Pediatric Hematology/Oncology, 2016
Survival for childhood acute lymphoblastic leukemia (ALL) has improved significantly, but these benefits may not be available to many children from low and middle income countries, where reasons for treatment failure may be unique to their environment. We retrospectively reviewed data on pediatric (1 to 18 y or younger) patients with newly diagnosed ALL treated over 5 years at a children's cancer hospital in Pakistan. Patients were treated with modified Berlin-Frankfurt-Muenster-based therapy without risk stratification. There were 255 children with a median age of 7 years (mean, 7.65 y) and a male preponderance (M:F = 1.6:1). 20% had TALL , one-third had white blood cells >50Â10 9 /L and 13.7% central nervous system disease. A majority (56.5%) was malnourished. In total, 49 (19.2%) died before the end of induction and 21 died in complete remission. Most deaths were infection-related. A total of 50 patients relapsed and 19 abandoned therapy after complete remission. Five-year overall survival is 52.9% with abandonment censored and 45.8% with abandonment as an event. Overall survival was related to socioeconomic status but not to known risk factors. The outcome of ALL at our center is suboptimal and associated with factors not commonly seen in developed countries. Special attention to early diagnosis, infection control, and parental educational are needed to improve the survival.
Jornal de pediatria, 2018
Acute lymphoblastic leukemia is the most common childhood cancer, yet surprisingly, very few studies have reported the treatment outcomes and the relapse rate of patients from low/middle-income countries. This study was a 5-year retrospective cohort study. It was conducted at Oncology Center of Mansoura University in Egypt and aimed to estimate the treatment outcomes and the relapse rates of newly diagnosed acute lymphoblastic leukemia in children. Two hundred children suffering from acute lymphoblastic leukemia were studied; forty-six patients (23%) died during induction and most of those deaths were related to infection. Forty-one patients (27%) relapsed out of the 152 patients who achieved complete remission. The most common site of relapse was the bone marrow, followed by the isolated central nervous system, 53.7% and 31.7%, respectively. Seventy-eight percent of relapses occurred very early/early rather than later. The majority of relapse patients' deaths were related to in...
Expert review of hematology, 2015
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.