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Adherence to childhood cancer treatment : A prospective cohort study from Northern Vietnam

Lan, Bui Ngoc; Castor, Anders LU ; Wiebe, Thomas LU ; Toporski, Jacek LU ; Moëll, Christian LU and Hagander, Lars LU (2019) In BMJ Open 9(8). p.1-9
Abstract

Objectives Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low-and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. Design A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. Setting The largest tertiary paediatric oncology centre in Northern Vietnam. Participants All children offered curative cancer treatment, from January 2008 to December 2009. Primary and secondary outcome measures Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was... (More)

Objectives Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low-and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. Design A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. Setting The largest tertiary paediatric oncology centre in Northern Vietnam. Participants All children offered curative cancer treatment, from January 2008 to December 2009. Primary and secondary outcome measures Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment. Results Among 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03). Conclusions Non-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
paediatric oncology, paediatric surgery, public health
in
BMJ Open
volume
9
issue
8
pages
1 - 9
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85070356528
ISSN
2044-6055
DOI
10.1136/bmjopen-2018-026863
language
English
LU publication?
yes
id
312c7d65-8415-4076-bbbb-4c75fae9d806
date added to LUP
2019-08-28 13:00:48
date last changed
2019-09-11 04:22:53
@article{312c7d65-8415-4076-bbbb-4c75fae9d806,
  abstract     = {<p>Objectives Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low-and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. Design A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. Setting The largest tertiary paediatric oncology centre in Northern Vietnam. Participants All children offered curative cancer treatment, from January 2008 to December 2009. Primary and secondary outcome measures Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment. Results Among 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=&lt;0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03). Conclusions Non-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.</p>},
  articleno    = {e026863},
  author       = {Lan, Bui Ngoc and Castor, Anders and Wiebe, Thomas and Toporski, Jacek and Moëll, Christian and Hagander, Lars},
  issn         = {2044-6055},
  keyword      = {paediatric oncology,paediatric surgery,public health},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {1--9},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Adherence to childhood cancer treatment : A prospective cohort study from Northern Vietnam},
  url          = {http://dx.doi.org/10.1136/bmjopen-2018-026863},
  volume       = {9},
  year         = {2019},
}