Magnitude of Treatment Abandonment in Childhood Cancer
Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and popu...
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| description | Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data.
Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted.
602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children |
| doi_str_mv | 10.1371/journal.pone.0135230 |
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Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted.
602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC.
Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0135230</identifier><identifier>PMID: 26422208</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abandonment ; Adolescent ; Age Factors ; Analysis ; Blood diseases ; Cancer ; Cancer therapies ; Cancer treatment ; Child ; Child, Preschool ; Childhood ; Childhood cancer ; Children ; Collaboration ; Developing Countries ; Development and progression ; Drug therapy ; Equivalence ; Female ; Global Health ; Health risks ; Hematology ; Hospitals ; Humans ; Income ; Infant ; Infant, Newborn ; Low income areas ; Low income groups ; Male ; Malnutrition ; Medical diagnosis ; Medical personnel ; Neoplasms - epidemiology ; Oncology ; Patient compliance ; Patient Outcome Assessment ; Pediatrics ; Physicians ; Population Surveillance ; Poverty ; Radiation ; Refusal to Treat - statistics & numerical data ; Risk Factors ; Surveys ; Surveys and Questionnaires ; Survival ; Toxic diseases ; Toxicity ; Working groups</subject><ispartof>PloS one, 2015-09, Vol.10 (9), p.e0135230</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Friedrich 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>2015 Friedrich et al 2015 Friedrich et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-32024cb753f8ef11a3cf689bc8921ba8a329c7e8d1b313635f88d884d72e86ed3</citedby><cites>FETCH-LOGICAL-c692t-32024cb753f8ef11a3cf689bc8921ba8a329c7e8d1b313635f88d884d72e86ed3</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/PMC4589240/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589240/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26422208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Friedrich, Paola</creatorcontrib><creatorcontrib>Lam, Catherine G</creatorcontrib><creatorcontrib>Itriago, Elena</creatorcontrib><creatorcontrib>Perez, Rafael</creatorcontrib><creatorcontrib>Ribeiro, Raul C</creatorcontrib><creatorcontrib>Arora, Ramandeep S</creatorcontrib><title>Magnitude of Treatment Abandonment in Childhood Cancer</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data.
Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted.
602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC.
Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.</description><subject>Abandonment</subject><subject>Adolescent</subject><subject>Age Factors</subject><subject>Analysis</subject><subject>Blood diseases</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Cancer treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood</subject><subject>Childhood cancer</subject><subject>Children</subject><subject>Collaboration</subject><subject>Developing Countries</subject><subject>Development and progression</subject><subject>Drug therapy</subject><subject>Equivalence</subject><subject>Female</subject><subject>Global Health</subject><subject>Health risks</subject><subject>Hematology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Income</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Low income areas</subject><subject>Low income groups</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Medical diagnosis</subject><subject>Medical personnel</subject><subject>Neoplasms - epidemiology</subject><subject>Oncology</subject><subject>Patient compliance</subject><subject>Patient Outcome Assessment</subject><subject>Pediatrics</subject><subject>Physicians</subject><subject>Population Surveillance</subject><subject>Poverty</subject><subject>Radiation</subject><subject>Refusal to Treat - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Surveys</subject><subject>Surveys and Questionnaires</subject><subject>Survival</subject><subject>Toxic diseases</subject><subject>Toxicity</subject><subject>Working groups</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl2L1DAUhoso7rr6D0QHhAUvZsxHm6Q3wjCsOrCyoKu3Ic1Hm6FNxiQV_fdmdrrLFBQkFzkkz3lz3pNTFC8hWEFM4budH4MT_WrvnV4BiCuEwaPiHNYYLQkC-PFJfFY8i3EHQIUZIU-LM0RKhBBg5wX5LFpn06j0wpvFbdAiDdqlxboRTnl3F1u32HS2V533arERTurwvHhiRB_1i2m_KL59uLrdfFpe33zcbtbXS0lqlJYYAVTKhlbYMG0gFFgawupGshrBRjCBUS2pZgo2GGKCK8OYYqxUFGlGtMIXxeuj7r73kU-WI4c0WyuziyoT2yOhvNjxfbCDCL-5F5bfHfjQchGSlb3mignAGkMRhbqEStd1lSUEJQ1pqESH195Pr43NoJXM5oPoZ6LzG2c73vqfvKyyoRJkgTeTQPA_Rh3TP0qeqFbkqqwzPovJwUbJ1yUGuKpLSDO1-guVl9KDlfnTjc3ns4S3s4TMJP0rtWKMkW-_fvl_9ub7nL08YTst-tRF34_JehfnYHkEZfAxBm0eOgcBP8zsfTf4YWb5NLM57dVp1x-S7ocU_wFsNeTW</recordid><startdate>20150930</startdate><enddate>20150930</enddate><creator>Friedrich, Paola</creator><creator>Lam, Catherine G</creator><creator>Itriago, Elena</creator><creator>Perez, Rafael</creator><creator>Ribeiro, Raul C</creator><creator>Arora, Ramandeep S</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150930</creationdate><title>Magnitude of Treatment Abandonment in Childhood Cancer</title><author>Friedrich, Paola ; Lam, Catherine G ; Itriago, Elena ; Perez, Rafael ; Ribeiro, Raul C ; Arora, Ramandeep S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-32024cb753f8ef11a3cf689bc8921ba8a329c7e8d1b313635f88d884d72e86ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abandonment</topic><topic>Adolescent</topic><topic>Age Factors</topic><topic>Analysis</topic><topic>Blood diseases</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Cancer treatment</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Childhood</topic><topic>Childhood cancer</topic><topic>Children</topic><topic>Collaboration</topic><topic>Developing Countries</topic><topic>Development and progression</topic><topic>Drug therapy</topic><topic>Equivalence</topic><topic>Female</topic><topic>Global Health</topic><topic>Health risks</topic><topic>Hematology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Income</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Low income areas</topic><topic>Low income groups</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Medical diagnosis</topic><topic>Medical personnel</topic><topic>Neoplasms - epidemiology</topic><topic>Oncology</topic><topic>Patient compliance</topic><topic>Patient Outcome Assessment</topic><topic>Pediatrics</topic><topic>Physicians</topic><topic>Population Surveillance</topic><topic>Poverty</topic><topic>Radiation</topic><topic>Refusal to Treat - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Surveys</topic><topic>Surveys and Questionnaires</topic><topic>Survival</topic><topic>Toxic diseases</topic><topic>Toxicity</topic><topic>Working groups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Friedrich, Paola</creatorcontrib><creatorcontrib>Lam, Catherine G</creatorcontrib><creatorcontrib>Itriago, Elena</creatorcontrib><creatorcontrib>Perez, Rafael</creatorcontrib><creatorcontrib>Ribeiro, Raul C</creatorcontrib><creatorcontrib>Arora, Ramandeep S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data.
Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted.
602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC.
Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26422208</pmid><doi>10.1371/journal.pone.0135230</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-09, Vol.10 (9), p.e0135230 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1719342645 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Abandonment Adolescent Age Factors Analysis Blood diseases Cancer Cancer therapies Cancer treatment Child Child, Preschool Childhood Childhood cancer Children Collaboration Developing Countries Development and progression Drug therapy Equivalence Female Global Health Health risks Hematology Hospitals Humans Income Infant Infant, Newborn Low income areas Low income groups Male Malnutrition Medical diagnosis Medical personnel Neoplasms - epidemiology Oncology Patient compliance Patient Outcome Assessment Pediatrics Physicians Population Surveillance Poverty Radiation Refusal to Treat - statistics & numerical data Risk Factors Surveys Surveys and Questionnaires Survival Toxic diseases Toxicity Working groups |
| title | Magnitude of Treatment Abandonment in Childhood Cancer |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T19%3A50%3A16IST&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=Magnitude%20of%20Treatment%20Abandonment%20in%20Childhood%20Cancer&rft.jtitle=PloS%20one&rft.au=Friedrich,%20Paola&rft.date=2015-09-30&rft.volume=10&rft.issue=9&rft.spage=e0135230&rft.pages=e0135230-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0135230&rft_dat=%3Cgale_plos_%3EA430359417%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=1719342645&rft_id=info:pmid/26422208&rft_galeid=A430359417&rft_doaj_id=oai_doaj_org_article_d8a08bf7271e41de995264a76b6b7c2d&rfr_iscdi=true |