The magnitude and predictors of therapy abandonment in pediatric central nervous system tumors in low‐ and middle‐income countries: Systematic review and meta‐analysis

Abstract

Background Outcomes of pediatric central nervous system (CNS) tumors in low‐ to middle‐income countries (LMIC) are poorer than their high‐income counterparts. Abandonment of therapy is increasingly recognized as a key contributor to this disparity, but has been poorly quantified. We performed a meta‐analysis to determine the magnitude of abandonment in pediatric CNS tumors in LMIC, and risk factors and interventions aimed at reducing this. Patients and methods We searched seven databases for pediatric CNS tumor cohorts followed up from diagnosis and treated in LMIC. All languages were included. Two reviewers independently selected articles and extracted data on abandonment rates (ARs) and predictors. The authors were contacted for additional information. Results Of 50 660 publications, 643 in five languages met criteria for full review; 131 met analysis inclusion criteria. ARs were not reported in the majority, and a small number were available from the authors. Available ARs ranged from 0% to 59%, from 38 studies (2497 children in 14 countries), and these were quantitatively analyzed. Lower‐middle‐income countries had higher ARs than upper‐middle‐income countries (27%, 95% confidence interval [CI] 20%–36% vs 9%, 95% CI 6%–14%, P < 0.0001), with significant heterogeneity within each (LMIC I2 = 78%, P < 0.00001, UMIC I2 = 85%, P < 0.00001). Common predictors for abandonment included distance to treatment centers, financial hardship, and prognostic misconceptions. Conclusion In LMICs, ARs are highest in lower‐MICs. However, the paucity of published data limits further evaluation. Given the increasing burden of pediatric CNS tumors in LMIC, addressing deficits in abandonment reporting is critical. Consistent reporting is needed for developing interventions to improve outcomes.

Leukemia mortality in children from Latin America: Trends and predictions to 2030

“…Venezuela is undergoing special socioeconomic and political instability (37), which may affect the current and future outcomes of childhood leukemia. Other reports have found that abandonment of treatment is a major barrier to successful treatment and remission of the disease in low-and middle-income countries in Central America (13,38,39). Moreover, economic disparities in certain communities within countries likely affect access to health services (34,40).…”

Sustainable care for children with cancer: a Lancet Oncology Commission

“…(i) Refusal and abandonment of therapy: refusal and abandonment of therapy is a major cause of therapeutic failure in countries with limited resources, where children and families incur unaffordable direct and indirect costs of care 18,19 , and affect up to 50-60% of children in some world regions -often exceeding all other causes of treatment failure. 11 Most children abandon early, usually after induction remission in leukaemias or at the time of radical surgeries (e.g.…”

“…We extended the Global Childhood Cancer microsimulation model, described in detail elsewhere 56 and briefly in appendix panels 1 and 2 (pp. [16][17][18][19], to project the number of childhood cancer deaths worldwide between 2020 and 2050 for children diagnosed and undiagnosed with cancer.…”

Leukemia mortality in children from Latin America: trends and predictions to 2030

“…However, childhood leukemia and economic status do not appear to be significantly related in high-income countries such as Switzerland or the US [ 31 , 36 ], suggesting that others factors have contribute to leukemia mortality. For example, some reports found that abandonment of treatment is a major barrier to successful treatment and remission of the disease in low- and middle-income countries [ 14 , 37 , 38 ], which could increase the mortality rates in this population. Although these inequities are plausible explanations for the unremarkable trends seen in our analysis, there is still the need to explore further factors such as environmental hazard or components of the healthcare system, to generate tailored and evidence-based health policies.…”