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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(04): 501-506
DOI: 10.4103/ijmpo.ijmpo_84_18
Original Article

Treatment Adherence and Abandonment in Acute Myeloid Leukemia in Pediatric Patients at a Low-Resource Cancer Center in India

Sudha Sinha
Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
,
Gustav Brattström
Faculty of Medicine, University of Lund, Lund, Sweden
,
Gayatri Palat
Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
,
Vineela Rapelli
Palliative Care Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
,
Mikael Segerlantz
Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University
Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane
,
Eva Brun
Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University
Department of Radiotherapy and Radiophysics, Skane University Hospital
,
Thomas Wiebe
Department of Clinical Sciences, Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

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.

Keywords

Abandonment to treatment - acute childhood leukemia - Low middle income countries


Publication History

Received: 13 April 2018

Accepted: 18 October 2018

Article published online:
03 June 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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