Holistic support coupled with prospective tracking reduces abandonment in childhood cancers: A report from India

Abstract

Background High cure rates of over 80% in childhood cancers reported from high‐income countries (HICs) are not replicated in low‐ and middle‐income countries (LMICs). Treatment abandonment (TxA) is an important reason for this poorer outcome. We assessed the effect of a holistic support group approach coupled with prospective tracking on TxA in children with cancer in a limited‐resources environment. Methods In 2010, all existing nongovernmental organizations (NGOs) working with childhood cancer at our hospital were brought together to form a pediatric cancer foundation with the aim of providing holistic support to the patient and family, including financial, psychosocial, lodging, educational, and bereavement support. Simultaneously, prospective tracking of all children with a Time‐Responsive Electronic Abandonment Tracking (TREAT) system was also established. The impact of these measures on TxA over the 2009–2016 period was compared using the log‐rank test. Results The annual rate of abandonment reduced from 20% in 2009 to 10.4% in 2010 and 5.2% in 2011. It has been consistently between 3% and 6% from 2012 to 2016 (P −0.04). TxA after the initiation of treatment dropped from 9% in 2009 to 1% in 2016 (P −0.02), while refusal to initiate treatment dropped from 11% to 2.7% (P −0.23) over the same period. Conclusions A holistic support group consisting of the hospital team, as well as existing NGOs and governmental organizations, along with a systematic and prospective tracking system significantly reduced abandonment in a resource‐constrained setting. This cost‐effective holistic support group may be applicable in other LMICs with similar healthcare systems.

Sustainable care for children with cancer: a Lancet Oncology Commission

“…has resulted in a substantial improvements on treatment outcomes, highlighting the critical role of psychosocial packages in comprehensive childhood cancer care. 96,97,98 A key principle of successful paediatric cancer treatment is the delivery of care by skilled professional nurses. However, specialized education and training is generally unavailable for nurses in LMICs; this lack of training, coupled with high workload and cultural and organizational barriers contribute to the disparity in outcomes and overall survival.…”

“…It receives funding from multiple sources, including Tata Trust, the federal government through the Department of Atomic Energy (a more stable source of funding compared to state funds for health), private and public insurance schemes for providing care, corporate donations, and philanthropy from individual donors and non-governmental organizations. Tata Memorial Centre's Improving Pediatric Cancer Care and Treatment (ImPaCCT) Foundation, funded from philanthropic sources, enables access to comprehensive cancer care for children regardless of socioeconomic background bydefraying medical costs, provides nutritional support for patients and organises free accommodation with psychosocial services for caregivers -an holistic approach that helps to reduce abandonment of treatment 88.…”

Comment on: The COVID‐19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP‐E, SIOP‐PODC, IPSO, PROS, CCI, and St Jude Global

“…Measures were initiated 2 weeks prior to the lockdown aimed at reducing outpatient footfall and conservation of supportive care resources and staff, as already detailed elsewhere. 3,4 Within this larger response, we tailored management of pediatric cancers to meet the twin objectives of retaining hard-fought recent improvements in disease outcomes of largely curable malignancies, 5,6 while balancing resource constraints from disruption of services, and evolving strategies for the inevitable cancer with COVID-19 patient surge. Our priority was to immediately reduce the average of 300 daily outpatient visits to pediatric cancer units by more than 50%.…”

“…These strategies have consistently yielded us acceptable and often excellent outcomes. [5][6][7][8] We rolled out a comprehensive set of measures including these and similar adaptations, and summarized them for easy reference. 9 These guidelines helped us to successfully brace for the ini- ORCID Chetan Dhamne https://orcid.org/0000-0002-3637-2880…”

Post-induction Measurable Residual Disease Using Multicolor Flow Cytometry Is Strongly Predictive of Inferior Clinical Outcome in the Real-Life Management of Childhood T-Cell Acute Lymphoblastic Leukemia: A Study of 256 Patients

“…In LMIC, patients face challenges like exposure to communicable infections, malnutrition, and lack of adequate supportive care, etc. (10)(11)(12)(13)(14)(15). Additionally, due to financial constraints, majority of patients are treated with lowcost therapeutic protocols like MCP-841 (12,13,16).…”