Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia
There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with can...
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| Veröffentlicht in: | PloS one 2014-02, Vol.9 (2), p.e89102-e89102 |
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| creator | Slone, Jeremy S Chunda-Liyoka, Catherine Perez, Marta Mutalima, Nora Newton, Robert Chintu, Chifumbe Kankasa, Chipepo Chipeta, James Heimburger, Douglas C Vermund, Sten H Friedman, Debra L |
| description | There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.
Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.
Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).
Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome. |
| doi_str_mv | 10.1371/journal.pone.0089102 |
| format | Article |
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Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.
Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).
Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0089102</identifier><identifier>PMID: 24586527</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abandonment ; Adolescent ; Antiretroviral agents ; Antiretroviral therapy ; Cancer ; Cancer therapies ; Cancer treatment ; Child ; Child, Preschool ; Childhood cancer ; Children ; Cohort Studies ; Colleges & universities ; Confidence intervals ; Diagnosis ; Drug therapy ; HIV ; Human immunodeficiency virus ; Humans ; Infant ; Infant, Newborn ; Medical diagnosis ; Medical records ; Medical research ; Medicine ; Neoplasms - diagnosis ; Neoplasms - epidemiology ; Neoplasms - therapy ; Odds Ratio ; Patient Dropouts - statistics & numerical data ; Patient outcomes ; Patients ; Pediatrics ; Physicians ; Retrospective Studies ; Risk analysis ; Risk Factors ; Socioeconomic factors ; Teaching hospitals ; Treatment Outcome ; Viruses ; Zambia - epidemiology</subject><ispartof>PloS one, 2014-02, Vol.9 (2), p.e89102-e89102</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Slone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Slone et al 2014 Slone et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2a5779115dafc9627c4cdba8ffeede51e533b34ba928bda4dc6d1f46ec669f873</citedby><cites>FETCH-LOGICAL-c692t-2a5779115dafc9627c4cdba8ffeede51e533b34ba928bda4dc6d1f46ec669f873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931678/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931678/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24586527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Slone, Jeremy S</creatorcontrib><creatorcontrib>Chunda-Liyoka, Catherine</creatorcontrib><creatorcontrib>Perez, Marta</creatorcontrib><creatorcontrib>Mutalima, Nora</creatorcontrib><creatorcontrib>Newton, Robert</creatorcontrib><creatorcontrib>Chintu, Chifumbe</creatorcontrib><creatorcontrib>Kankasa, Chipepo</creatorcontrib><creatorcontrib>Chipeta, James</creatorcontrib><creatorcontrib>Heimburger, Douglas C</creatorcontrib><creatorcontrib>Vermund, Sten H</creatorcontrib><creatorcontrib>Friedman, Debra L</creatorcontrib><title>Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.
Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.
Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).
Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.</description><subject>Abandonment</subject><subject>Adolescent</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Cancer treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood cancer</subject><subject>Children</subject><subject>Cohort Studies</subject><subject>Colleges & universities</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Drug therapy</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Medical diagnosis</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Neoplasms - 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To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.
Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.
Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).
Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24586527</pmid><doi>10.1371/journal.pone.0089102</doi><tpages>e89102</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-02, Vol.9 (2), p.e89102-e89102 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1500940093 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Abandonment Adolescent Antiretroviral agents Antiretroviral therapy Cancer Cancer therapies Cancer treatment Child Child, Preschool Childhood cancer Children Cohort Studies Colleges & universities Confidence intervals Diagnosis Drug therapy HIV Human immunodeficiency virus Humans Infant Infant, Newborn Medical diagnosis Medical records Medical research Medicine Neoplasms - diagnosis Neoplasms - epidemiology Neoplasms - therapy Odds Ratio Patient Dropouts - statistics & numerical data Patient outcomes Patients Pediatrics Physicians Retrospective Studies Risk analysis Risk Factors Socioeconomic factors Teaching hospitals Treatment Outcome Viruses Zambia - epidemiology |
| title | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T11%3A41%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pediatric%20malignancies,%20treatment%20outcomes%20and%20abandonment%20of%20pediatric%20cancer%20treatment%20in%20Zambia&rft.jtitle=PloS%20one&rft.au=Slone,%20Jeremy%20S&rft.date=2014-02-21&rft.volume=9&rft.issue=2&rft.spage=e89102&rft.epage=e89102&rft.pages=e89102-e89102&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0089102&rft_dat=%3Cgale_plos_%3EA478796756%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1500940093&rft_id=info:pmid/24586527&rft_galeid=A478796756&rft_doaj_id=oai_doaj_org_article_bdf9bfa4682447a5bea4e266872464d1&rfr_iscdi=true |