Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia.
<h4>Background</h4>There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2014-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0089102&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850190089588572160 |
|---|---|
| author | Jeremy S Slone Catherine Chunda-Liyoka Marta Perez Nora Mutalima Robert Newton Chifumbe Chintu Chipepo Kankasa James Chipeta Douglas C Heimburger Sten H Vermund Debra L Friedman |
| author_facet | Jeremy S Slone Catherine Chunda-Liyoka Marta Perez Nora Mutalima Robert Newton Chifumbe Chintu Chipepo Kankasa James Chipeta Douglas C Heimburger Sten H Vermund Debra L Friedman |
| author_sort | Jeremy S Slone |
| collection | DOAJ |
| description | <h4>Background</h4>There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.<h4>Methods</h4>Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.<h4>Results</h4>Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).<h4>Conclusions</h4>Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome. |
| format | Article |
| id | doaj-art-bdf9bfa4682447a5bea4e266872464d1 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-bdf9bfa4682447a5bea4e266872464d12025-08-20T02:15:24ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0192e8910210.1371/journal.pone.0089102Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia.Jeremy S SloneCatherine Chunda-LiyokaMarta PerezNora MutalimaRobert NewtonChifumbe ChintuChipepo KankasaJames ChipetaDouglas C HeimburgerSten H VermundDebra L Friedman<h4>Background</h4>There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.<h4>Methods</h4>Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.<h4>Results</h4>Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).<h4>Conclusions</h4>Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0089102&type=printable |
| spellingShingle | Jeremy S Slone Catherine Chunda-Liyoka Marta Perez Nora Mutalima Robert Newton Chifumbe Chintu Chipepo Kankasa James Chipeta Douglas C Heimburger Sten H Vermund Debra L Friedman Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. PLoS ONE |
| title | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. |
| title_full | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. |
| title_fullStr | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. |
| title_full_unstemmed | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. |
| title_short | Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. |
| title_sort | pediatric malignancies treatment outcomes and abandonment of pediatric cancer treatment in zambia |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0089102&type=printable |
| work_keys_str_mv | AT jeremysslone pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT catherinechundaliyoka pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT martaperez pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT noramutalima pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT robertnewton pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT chifumbechintu pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT chipepokankasa pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT jameschipeta pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT douglascheimburger pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT stenhvermund pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia AT debralfriedman pediatricmalignanciestreatmentoutcomesandabandonmentofpediatriccancertreatmentinzambia |