Factors Associated With Default of Treatment and Follow-Up Among Patients With Cancer: A Cross-Sectional Study From a Lower-Middle-Income Country

Abstract

PURPOSE Desirable outcomes during the treatment of patients with cancer require adherence to evaluation, treatment, and follow-up. This study aimed to evaluate the factors associated with default in patients with cancer. MATERIALS AND METHODS We included patients with a histologically confirmed diagnosis of cancer who defaulted during evaluation, treatment, and follow-up. All patients’ detailed demographic and clinical data were recorded. Those lost to follow-up were interviewed telephonically. The factors associated with default were noted. Descriptive statistics were used to compute the demographic and clinical characteristics. RESULTS In total, 172 patients were included. Geriatric and female patients were 38.9% and 37.2%, respectively. Fifty-eight percent of the patients lived in rural areas, whereas 45.9% were illiterate. More than one third (34.3%) of the patients who defaulted received the curative-intent treatment, whereas 62.1% of patients had a good performance status immediately before default. The average distance traveled by the patients to reach the cancer facility was 143 ± 13.15 km. The most common reasons for default were the lack of social support, financial constraints, difficulty in commuting, and too sick to come in 45 (26.2%), 35 (20.3%), 28 (16.3%), and 23 (13.4%) patients, respectively. Twenty-nine (16.9%) patients reported more than one reason for default. CONCLUSION Lack of social support, financial constraints, transportation barriers, and inadequate counseling by the health care provider serve as barriers to uninterrupted cancer care. These factors are often interrelated and can be attenuated by adopting the hub and spoke model. Simultaneously, a good relationship between the patient and the health care provider fostered by appropriate counseling is imperative to increase adherence to cancer treatment and improve the outcome.