Treatment abandonment: A report from the collaborative African network for childhood cancer care and research—CANCaRe Africa

Sweden's population is gradually changing to become more multiethnic and diverse and that applies also for recipients of health care, including childhood cancer care. A holistic view on the sick child in the context of its family has always been a cornerstone in childhood cancer care in Sweden. The purpose of this study was to gain knowledge about the experiences and main concern of foreign-born parents in the context of paediatric cancer care. Interviews were performed with eleven foreign-born parents and data were analysed using a classic grounded theory approach. Foreign-born parents often feel in a position of powerless dependence, but family interests are protected in their approaches to interaction with healthcare staff, through cooperation, contesting, and reluctant resigning. Healthcare staff need to listen to foreign-born parents and deal with their concerns seriously to prevent powerless-dependence and work for trustful cooperation in the common fight against childhood cancer.

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Childhood cancer care in the Middle East, North Africa, and West/Central Asia: A snapshot across five countries from the POEM network

Cancer Epidemiology ◽

10.1016/j.canep.2020.101727 ◽

2020 ◽

pp. 101727

Author(s):

Maya Basbous ◽

Mazin Al-Jadiry ◽

Asim Belgaumi ◽

Iyad Sultan ◽

Alaa Al-Haddad ◽

...

Keyword(s):

Middle East ◽

Childhood Cancer ◽

Central Asia ◽

North Africa ◽

Cancer Care ◽

West Central

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Using data to improve childhood cancer care in low and low-middle income countries, Ghana as an example

Pediatric Hematology Oncology Journal ◽

10.1016/j.phoj.2018.10.003 ◽

2018 ◽

Vol 3 (4) ◽

pp. 99-101 ◽

Cited By ~ 1

Author(s):

Lorna Awo Renner ◽

Catherine Segbefia ◽

Emmanuel Amankwah

Keyword(s):

Childhood Cancer ◽

Cancer Care ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Using Data

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

BMJ Open ◽

10.1136/bmjopen-2018-026863 ◽

2019 ◽

Vol 9 (8) ◽

pp. e026863

Author(s):

Bui Ngoc Lan ◽

Anders Castor ◽

Thomas Wiebe ◽

Jacek Toporski ◽

Christian Moëll ◽

...

Keyword(s):

Cohort Study ◽

Cancer Treatment ◽

Childhood Cancer ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cox Model ◽

Secondary Outcome ◽

Northern Vietnam ◽

Family Decision ◽

Treatment Abandonment

ObjectivesGlobal 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.DesignA prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors.SettingThe largest tertiary paediatric oncology centre in Northern Vietnam.ParticipantsAll children offered curative cancer treatment, from January 2008 to December 2009.Primary and secondary outcome measuresFamily 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.ResultsAmong 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).ConclusionsNon-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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Access to WHO Essential Medicines for Childhood Cancer Care in Trinidad and Tobago: A Health System Analysis of Barriers and Enablers

JCO Global Oncology ◽

10.1200/jgo.19.00300 ◽

2020 ◽

pp. 67-79 ◽

Cited By ~ 1

Author(s):

Brandon Tang ◽

Curt Bodkyn ◽

Sumit Gupta ◽

Avram Denburg

Keyword(s):

Trinidad And Tobago ◽

Childhood Cancer ◽

Cancer Care ◽

System Analysis ◽

Essential Medicines ◽

Middle Income ◽

Essential Medicines List ◽

Mixed Methods Case Study ◽

Relevant Evidence ◽

Context Specific

PURPOSE Improving access to essential medicines is necessary to reduce global mortality resulting from childhood cancer. However, there is a lack of context-specific data in many low- to middle-income countries on the determinants of access to essential childhood cancer medicines. We conducted a mixed-methods case study of the barriers to and enablers of access to WHO essential medicines for childhood cancer care in Trinidad and Tobago, in response to domestic calls for policy attention and reform. METHODS We interviewed stakeholders (N = 9) across the pharmaceutical supply system using a novel analytic framework and qualitative interview guide. Interviews were recorded, transcribed, and analyzed with constant comparative methods to capture emergent themes. Quantitatively, we examined alignment of the national essential medicines list with the 2017 WHO Essential Medicines List for Children (EMLc). National buyer prices for EMLc cancer medicines were compared with median international prices, with calculation of median price ratios to assess procurement efficiency. RESULTS Principal barriers identified included a lack of data-driven procurement, low supplier incentive to engage in tenders, reactive rather than proactive processes in response to stockouts, and siloed information systems. Recurring themes of regionalization, standardization, and proactivity emerged as priorities for policy reform. Quantitative analysis of the national essential medicines list and median price ratios for procured medicines aligned with findings reported qualitatively. CONCLUSION Our study contributes to global efforts to improve childhood cancer care by identifying policy-relevant evidence on access to essential childhood cancer medicines and providing a model for future studies in other jurisdictions.

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My child matters program: A UICC-sanofi-aventis partnership to improve pediatric cancer care in developing countries

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9526 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9526-9526 ◽

Cited By ~ 1

Author(s):

R. C. Ribeiro ◽

T. Eden ◽

J. Hartford ◽

J. Lemerle ◽

I. Magrath ◽

...

Keyword(s):

Developing Countries ◽

Access To Care ◽

Childhood Cancer ◽

Low Income ◽

Professional Education ◽

Cancer Care ◽

Developed Countries ◽

Political Support ◽

Outcome Analysis ◽

Children With Cancer

9526 Background: Despite dramatic advances in curing childhood cancer in developed countries, most children with cancer live in low-income countries, where misdiagnosis, late diagnosis, lack of access to treatment and abandonment of treatment hinder progress. Methods: In 2004 the International Union against Cancer and sanofi-aventis initiated a campaign to improve childhood cancer care in developing countries through grants for local projects (up to 50,000 euros/year each), a survey of childhood cancer care (conducted by the public health consulting firm Sanisphere), and lobbying to increase political support. The projects focus on professional education, improved access to care, pain management, and psychosocial/educational support. Results: During 2006, 14 pilot projects in Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam were selected on the basis of feasibility, expected benefit, sustainability, and potential to serve as models. Only eight countries had pediatric hematology/oncology units, ranging from 20 (Tanzania) to 350 (Egypt) beds. These units manage 100 (Senegal) to 1,000 (Bangladesh) children with cancer per year (a small fraction of actual cases in these countries). One-year outcome analysis showed that various short-term objectives were met, including improved patient care infrastructure, public and professional education, earlier detection, improved access to care, the introduction of psychosocial support, decreased abandonment and better follow up. On the basis of these results, 12 additional projects have been funded in Bolivia, Indonesia, Kenya, Mali, Peru and Romania. Conclusions: Relatively small investments, accompanied by external mentoring, can help build sustainable capacity for the diagnosis and care of children with cancer in selected institutions in developing countries. No significant financial relationships to disclose.

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