Sumit Gupta1, Stacy Yeh2, Alexandra Martiniuk3, Catherine G Lam4, Heui-Yang Chen5, Yen-Lin Liu6, Argerie Tsimicalis7, Ramandeep S Arora8, Raul C Ribeiro4. 1. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada. Electronic address: sumit.gupta@sickkids.ca. 2. Faculty of Medicine, University of Toronto, Toronto, Canada. 3. George Institute for Global Health, University of Sydney, Sydney, Australia. 4. International Outreach Program and Department of Oncology, St. Jude Children's Research Hospital, Memphis, USA. 5. Curtin-Monash Accident Research Center, Curtin University, Perth, Australia. 6. Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan. 7. Ingram School of Nursing, McGill University, Montreal, Canada. 8. Pediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK.
Abstract
BACKGROUND: Abandonment of therapy is a significant cause of paediatric cancer treatment failure in low- to middle-income countries (LMIC), but its impact has been underestimated. We performed a meta-analysis to determine the magnitude of abandonment in paediatric leukaemia in LMIC and sought to identify patient-, centre- and country-specific predictors of abandonment. PATIENTS AND METHODS: We searched seven databases to identify paediatric oncology cohorts followed up from diagnosis and treated in LMIC. All languages were included. Two reviewers independently selected articles and extracted data. Authors were contacted for additional information. Subgroup analyses were planned a priori. RESULTS: Of 22,384 publications, 318 in eight languages met criteria for full text review. 157 studies met analysis inclusion criteria. Abandonment rates (ARs), obtained for 83 of the 157 studies (52.9%), ranged from 0% to 74.5%. ARs were frequently unreported and available only directly from authors. Forty studies (10,494 children in 20 countries) were quantitatively analysed. ARs for acute lymphoblastic laeukemia in lower-middle-income countries (lower-MICs) were higher than in upper-middle-income countries (29%, 95% confidence interval (CI) 23-36% versus 2%, 95% CI 1-3%; p<0.0001) but were heterogeneous (I(2)=98%; p<0.0001). This heterogeneity was not explained by centre-specific (free versus paid treatment) or country-specific (government health expenditure, per-capital income) subgroups. CONCLUSIONS: In LMICs, ARs are highest in lower-MICs. However, their broad range suggests that low ARs are possible in resource-constrained settings. Analysis of outliers may suggest interventions for use at other centres. Methodologically appropriate reporting of ARs should be adopted. Future research should evaluate interventions targeting abandonment.
BACKGROUND: Abandonment of therapy is a significant cause of paediatric cancer treatment failure in low- to middle-income countries (LMIC), but its impact has been underestimated. We performed a meta-analysis to determine the magnitude of abandonment in paediatric leukaemia in LMIC and sought to identify patient-, centre- and country-specific predictors of abandonment. PATIENTS AND METHODS: We searched seven databases to identify paediatric oncology cohorts followed up from diagnosis and treated in LMIC. All languages were included. Two reviewers independently selected articles and extracted data. Authors were contacted for additional information. Subgroup analyses were planned a priori. RESULTS: Of 22,384 publications, 318 in eight languages met criteria for full text review. 157 studies met analysis inclusion criteria. Abandonment rates (ARs), obtained for 83 of the 157 studies (52.9%), ranged from 0% to 74.5%. ARs were frequently unreported and available only directly from authors. Forty studies (10,494 children in 20 countries) were quantitatively analysed. ARs for acute lymphoblastic laeukemia in lower-middle-income countries (lower-MICs) were higher than in upper-middle-income countries (29%, 95% confidence interval (CI) 23-36% versus 2%, 95% CI 1-3%; p<0.0001) but were heterogeneous (I(2)=98%; p<0.0001). This heterogeneity was not explained by centre-specific (free versus paid treatment) or country-specific (government health expenditure, per-capital income) subgroups. CONCLUSIONS: In LMICs, ARs are highest in lower-MICs. However, their broad range suggests that low ARs are possible in resource-constrained settings. Analysis of outliers may suggest interventions for use at other centres. Methodologically appropriate reporting of ARs should be adopted. Future research should evaluate interventions targeting abandonment.
Authors: Soad Fuentes-Alabi; Nickhill Bhakta; Roberto Franklin Vasquez; Sumit Gupta; Susan E Horton Journal: Cancer Date: 2017-09-15 Impact factor: 6.860
Authors: K Ford; S Gunawardana; E Manirambona; G S Philipoh; B Mukama; A Kanyamuhunga; P Cartledge; M J Nyoni; D Mwaipaya; J Mpwaga; Z Bokhary; T Scanlan; T Heinsohn; H Hathaway; R Mansfield; S Wilson; K Lakhoo Journal: World J Surg Date: 2020-01 Impact factor: 3.352
Authors: Paola Friedrich; Catherine G Lam; Elena Itriago; Rafael Perez; Raul C Ribeiro; Ramandeep S Arora Journal: PLoS One Date: 2015-09-30 Impact factor: 3.240