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

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

Publikationsverlauf

Eingereicht: 13. April 2018

Angenommen: 18. Oktober 2018

Artikel online veröffentlicht:
03. Juni 2021

• References

• 1 Arora RS, Eden T, Pizer B. The problem of treatment abandonment in children from developing countries with cancer. Pediatr Blood Cancer 2007; 49: 941-6
• 2 Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer 2009; 46: 264-73
• 3 Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L. et al. Toward the cure of all children with cancer through collaborative efforts: Pediatric oncology as a global challenge. J Clin Oncol 2015; 33: 3065-73
• 4 Swaminathan R, Sankaranarayanan R. Under-diagnosis and under-ascertainment of cases may be the reasons for low childhood cancer incidence in rural India. Cancer Epidemiol 2010; 34: 107-8
• 5 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127: 2893-917
• 6 Rodriguez-Galindo C, Friedrich P, Morrissey L, Frazier L. Global challenges in pediatric oncology. Curr Opin Pediatr 2013; 25: 3-15
• 7 Demanelis K, Sriplung H, Meza R, Wiangnon S, Rozek LS, Scheurer ME. et al. Differences in childhood leukemia incidence and survival between Southern Thailand and the United States: A population-based analysis. Pediatr Blood Cancer 2015; 62: 1790-8
• 8 Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK. et al. Paediatric cancer in low-income and middle-income countries. Lancet Oncol 2013; 14: e104-16
• 9 Ribeiro RC, Steliarova-Foucher E, Magrath I, Lemerle J, Eden T, Forget C. et al. Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving my child matters support: A descriptive study. Lancet Oncol 2008; 9: 721-9
• 10 The World Bank Group – Health Expenditure, Public (% of GDP). Available from: http://www.data.worldbank.org/indicator/SH.XPD.PUBL.ZS. [Last accessed on 2017 Mar 30]
• 11 Yadav SP, Rastogi N, Kharya G, Misra R, Ramzan M, Katewa S. et al. Barriers to cure for children with cancer in India and strategies to improve outcomes: A report by the Indian pediatric hematology oncology group. Pediatr Hematol Oncol 2014; 31: 217-24
• 12 Mostert S, Arora RS, Arreola M, Bagai P, Friedrich P, Gupta S. et al. Abandonment of treatment for childhood cancer: Position statement of a SIOP PODC working group. Lancet Oncol 2011; 12: 719-20
• 13 Njuguna F, Mostert S, Slot A, Langat S, Skiles J, Sitaresmi MN. et al. Abandonment of childhood cancer treatment in Western Kenya. Arch Dis Child 2014; 99: 609-14
• 14 Ramzan M, Yadav SP, Sachdeva A. Treatment abandonment is a major hurdle to improving survival in childhood cancer in the developing world. Pediatr Blood Cancer 2013; 60: 159-60
• 15 Gupta S, Yeh S, Martiniuk A, Lam CG, Chen HY, Liu YL. et al. The magnitude and predictors of abandonment of therapy in paediatric acute leukaemia in middle-income countries: A systematic review and meta-analysis. Eur J Cancer 2013; 49: 2555-64
• 16 Mostert S, Gunawan S, Wolters E, van de Ven P, Sitaresmi M, Dongen JV. et al. Socio-economic status plays important roles in childhood cancer treatment outcome in Indonesia. Asian Pac J Cancer Prev 2012; 13: 6491-6
• 17 Spinetta JJ, Masera G, Eden T, Oppenheim D, Martins AG, van Dongen-Melman J. et al. Refusal, non-compliance, and abandonment of treatment in children and adolescents with cancer: A report of the SIOP working committee on phychosocial issues in pediatric oncology. Med Pediatr Oncol 2002; 38: 114-7
• 18 Weaver MS, Arora RS, Howard SC, Salaverria CE, Liu YL, Ribeiro RC. et al. A practical approach to reporting treatment abandonment in pediatric chronic conditions. Pediatr Blood Cancer 2015; 62: 565-70
• 19 Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: An Indian perspective. Pediatr Hematol Oncol 2011; 28: 257-68
• 20 de Rooij JD, Zwaan CM, van den Heuvel-Eibrink M. Pediatric AML: From biology to clinical management. J Clin Med 2015; 4: 127-49
• 21 Pui CH, Carroll WL, Meshinchi S, Arceci RJ. Biology, risk stratification, and therapy of pediatric acute leukemias: An update. J Clin Oncol 2011; 29: 551-65
• 22 Slone JS, Chunda-Liyoka C, Perez M, Mutalima N, Newton R, Chintu C. et al. Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. PLoS One 2014; 9: e89102
• 23 Mostert S, Njuguna F, Langat SC, Slot AJ, Skiles J, Sitaresmi MN. et al. Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: Parents’ social network and experiences with hospital retention policies. Psychooncology 2014; 23: 700-7
• 24 Rossell N, Gigengack R, Blume S. Childhood cancer in El Salvador: A preliminary exploration of parental concerns in the abandonment of treatment. Eur J Oncol Nurs 2015; 19: 370-5
• 25 Un data – UN Country Profile: India. Available from: http://www.data.un.org/CountryProfile.aspx?crName=INDIA. [Last accessed on 2017 Mar 30]
• 26 Sudha Sinha MD. Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderbad, Telungana, India. In: Brattström GM. editor Medical Student. Hyderabad, India: Lund University; 2015