Improvement in treatment abandonment in pediatric patients with cancer in Guatemala

Alvarez, Elysia; Seppa, Midori; Rivas, Silvia; Fuentes, Ana Lucía; Valverde, Patricia; Antillón‐Klussmann, Federico; Castellanos, Mauricio; Sweet-Cordero, E. Alejandro; Messacar, Kevin; Kurap, John; Bustamante, Marisol; Howard, Scott C.; Efron, Bradley; Luna‐Fineman, Sandra

doi:10.1002/pbc.26560

Cited by 42 publications

(48 citation statements)

References 27 publications

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“…Similarly, Vasquez et al, in 2018 in Peru, found a significant association between a higher risk of abandonment in patients with retinoblastoma . We did not find a higher frequency of treatment abandonment among patients younger than five years at diagnosis, as has been reported in other studies . More recently, Vasquez et al found no association between age and risk of treatment abandonment in Peru …”

Section: Discussionsupporting

confidence: 83%

“…However, it has been reported that Chinese females had a higher risk of refusing treatment and treatment abandonment compared with males . In addition, Alvarez et al reported an association between indigenous race/ethnicity and treatment abandonment in Guatemala, suggesting that race/ethnicity may be a surrogate for another factor such as cultural beliefs surrounding the attitudes toward Western medicine and alternative treatments. Perhaps this did not occur in our cohort due to the intense miscegenation of the Brazilian people and the consequent difficulty in defining ethnicities.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment abandonment has been addressed in Latin America, especially in patients with childhood cancer and leukemia as an important cause of treatment failure, and strategies to overcome this problem have been implemented. However, fewer studies have focused specifically on solid tumors .…”

Section: Introductionmentioning

confidence: 99%

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Preventing treatment abandonment for children with solid tumors: A single‐center experience in Brazil

Ferman

Lima

Lage

et al. 2019

Pediatric Blood & Cancer

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Background High rates of treatment abandonment have been considered one of the major limitations to achieving high cure rates of childhood cancer in developing countries. The aims of this study were to report the prevalence and factors associated with treatment abandonment for children diagnosed with solid tumors in one reference center in Brazil and to describe effective strategies to prevent it. Procedures A retrospective review was conducted using data from 1139 children (0–18 years) treated for solid tumors at the Brazilian National Cancer Institute, during the period between January 2012 and December 2017. Treatment abandonment was defined as recommended by the International Society of Pediatric Oncology. The impact of implementing a patient‐tracking system was evaluated. Descriptive statistics were used to analyze patient characteristics. Chi‐square test was used for statistical analysis, with the significance level <0.05. Results Of 1139 patients, 1.66% refused or abandoned treatment. Although from 2012 to 2013 there was an increase in the abandonment rate, it then decreased by 63.8% from 2013 to 2017 (2.5% to 0.9%). In the multivariate model, only retinoblastoma diagnosis was associated with abandonment (odds ratio = 5.0; 95% confidence interval, 1.2–20.4; P = 0.025). In our cohort, abandonment rates were not associated with increased death. Conclusion Monitoring missed appointments, and early interventions to address issues associated with providing resources to help families during treatment were effective in achieving very low abandonment rates.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Preventing treatment abandonment for children with solid tumors: A single‐center experience in Brazil

Ferman

Lima

Lage

et al. 2019

Pediatric Blood & Cancer

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“…Determinants of TxA in our study (socioeconomic factors, perceived prognosis of disease, concerns about toxicity, and preference for TCAM) are very similar to those worldwide, as established in a global online survey, a systematic review, and other reports . Strategies to reduce abandonment are being studied and increasingly reported . Most centers have adopted overlapping strategies that stem from an increased understanding of the deficiencies common to most LMIC settings.…”

Section: Discussionsupporting

confidence: 56%

“…Most centers have adopted overlapping strategies that stem from an increased understanding of the deficiencies common to most LMIC settings. These usually tend to focus on one or more aspects of support and include setting up of local foundations, enhanced psychosocial support, education of families, subsidized or free treatment, food, transport, and lodging for families, and development of adapted treatment protocols, all of which have been found to decrease rates of TxA . A few reports have also focused on surveillance of treatment adherence and prospective tracking of patients, coupled with timely intervention .…”

Section: Discussionmentioning

confidence: 99%

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

Jatia

Prasad

Paradkar

et al. 2019

Pediatric Blood & Cancer

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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.

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Pediatric Early Warning Systems (PEWS) improve provider‐family communication from the provider perspective in pediatric cancer patients experiencing clinical deterioration

et al. 2022

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Background Communication between providers and patients' families is an integral part of clinical care. Family concern is a validated component of Pediatric Early Warning Systems (PEWS); however, little is known about the impact of PEWS on provider‐family communication. Methods Semi‐structured interviews were conducted with 83 ward and Pediatric Intensive Care Unit (PICU) providers involved in the care of patients with deterioration at two pediatric oncology hospitals of different resource levels: St. Jude Children's Research Hospital ( n = 42) in the United States and Unidad Nacional de Oncología Pediátrica (UNOP, n = 41) in Guatemala. Interviews were conducted in the participants' native language (English or Spanish), transcribed, and translated into English. Transcripts were coded by two researchers and analyzed for thematic content surrounding family communication and concern. Results All participants recognized patients' families as a valuable part of the care team, particularly during events requiring escalation of care. Perceived barriers to communication included limited time spent at the bedside, and, at UNOP, language and literacy challenges which occasionally limited providers' ability to assess family concern and involve families in patient care. Despite these barriers, providers perceived PEWS improved communication by facilitating more interaction with families, allowing for relationship‐building, anticipatory guidance, and destigmatization of the PICU. PEWS assessments also allowed families to contribute to identification of deterioration. Conclusions PEWS improve the quality of communication between providers and families by providing more opportunities for interaction, building relationships, and trust. These findings further support the use of PEWS in the care of children with cancer in hospitals of all resource‐levels.

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Improvement in treatment abandonment in pediatric patients with cancer in Guatemala

Cited by 42 publications

References 27 publications

Preventing treatment abandonment for children with solid tumors: A single‐center experience in Brazil

Preventing treatment abandonment for children with solid tumors: A single‐center experience in Brazil

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

Pediatric Early Warning Systems (PEWS) improve provider‐family communication from the provider perspective in pediatric cancer patients experiencing clinical deterioration

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