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- Title
Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi.
- Authors
Stanley, Christopher C.; van der Gronde, Toon; Westmoreland, Kate D.; Salima, Ande; Amuquandoh, Amy; Itimu, Salama; Manda, Agness; Mtete, Idah; Butia, Mercy; Mpasa, Atupele; Wachepa, Stella; Fox, Paula; Wasswa, Peter; Kazembe, Peter; El-Mallawany, Nader K.; Gopal, Satish
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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 and 16 (22%) Hodgkin's lymphoma. Forty-nine (68%) were male, median age was 10.6 years (interquartile range [IQR] 7.9-13.0), and 26 (36%) experienced treatment abandonment. Lack of guardian education and travel time ≥ 4 h to clinic were independently associated with treatment abandonment, with adjusted hazard ratio (aHR) 3.8 [95% confidence interval (CI) 1.5-8.9, p = 0.005] and aHR 2.9 (95% CI 1.2-6.9, p = 0.019), respectively. Commonest reasons for treatment abandonment endorsed by 15 guardians were community influence, suboptimal clinic environment, logistical challenges, transport costs, treatment toxicities, loss of hope, alternative healers, and beliefs about cure.<bold>Conclusions: </bold>These findings highlight families at risk for treatment abandonment, underlying reasons, and opportunities to improve retention in care for pediatric cancer patients in SSA.
- Subjects
MALAWI; LYMPHOMAS in children; CHILDHOOD cancer; HEALTH outcome assessment; LYMPHOMA diagnosis; BURKITT'S lymphoma; CHILDREN; THERAPEUTICS; CANCER risk factors; LYMPHOMA treatment; RESEARCH funding; PASSIVE euthanasia
- Publication
Supportive Care in Cancer, 2018, Vol 26, Issue 3, p967
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-017-3917-z