Destitution, treatment adherence and survival of children with Burkitt lymphoma in a twinning programme in Northwest Cameroon

Abstract

Background Burkitt lymphoma (BL) is a curable childhood cancer. Treatment adherence is crucial for a good outcome, but is potentially problematic in low‐ and middle‐income countries owing to parental financial constraints. Aims To investigate the association of destitution with treatment adherence and its effect on the survival of patients with BL. Methods Patients received free medical treatment from a twinning programme at two Cameroon Baptist hospitals. A destitution assessment questionnaire, based on socioeconomic status, was completed at diagnosis. Medical records were reviewed for treatment adherence and survival. Chi‐squared and Fisher's exact tests were used to compare groups. Kaplan‐Meier plots were used to calculate overall survival, and log‐rank chi‐squared tests when comparing survival rates between patient subgroups. Significance was measured at P < .05. Results The 225 children with BL had a mean age of 8.2 years (median 8.0) and the overall survival was 52%. The mean family destitution score was 56% on a linear scale. Few (8%) patients delayed treatment appointments. A quarter (25%) experienced more than a 1‐week follow‐up delay and 9.8% absconded within 1 year. The destitution score was not significantly associated with delay of treatment, but with delay in follow‐up (P < .001). Guardian relationship (single mother) and patient's age were significantly associated with overall survival (P = .025). Conclusions Though linked to poor follow‐up, destitution was not significantly associated with absconding patients, poor outcome or poor adherence to treatment, probably due to comprehensive financial support from the international twinning programme. However, additional support for single mothers should be considered.

Two decades of childhood cancer care in Cameroon: 2000–2020

“…Two of the reports addressed awareness, 7,11 10 addressed diagnosis, registration, and epidemiology, 5,[12][13][14][15][16][17][18][19][20] 18 addressed management and outcomes, 7,14,16,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] four addressed supportive care, [36][37][38][39] five addressed palliative care, [40][41][42][43][44] four addressed advocacy and F I G U R E 1 Map of Cameroon showing location of dedicated pediatric oncology units partnerships, 35,37,45,46 and one addressed T&CM 39 (Supporting Information File S1).…”

“…Two of the reports addressed awareness, 7,11 10 addressed diagnosis, registration, and epidemiology, 5,12–20 18 addressed management and outcomes, 7,14,16,21–35 four addressed supportive care, 36–39 five addressed palliative care, 40–44 four addressed advocacy and partnerships, 35,37,45,46 and one addressed T&CM 39 (Supporting Information File S1).…”

“…Patient destitution level had been reported to affect adherence to BL treatment in the region. Decreased survival rates were seen especially among children of single mothers, which highlighted the necessity for individualized psychosocial support to patients and families 39 …”

“…Decreased survival rates were seen especially among children of single mothers, which highlighted the necessity for individualized psychosocial support to patients and families. 39 A follow-up study of 87 BL patients who presented with paraplegia reports that 33% have been alive at a median follow-up of 40 months, with 24% having residual problems with mobility, bladder control, or bowel control. 26 This demonstrates that patients require long-term follow-up for residual problems to be identified and rehabilitation to be offered.…”

“…54 When focus. 11,17,39,47,57 Capacity building has occurred within the framework of regional and international research groups too, notably through FAPOG, the…”