Improvement in treatment abandonment in pediatric patients with cancer in Guatemala

Elysia Alvarez, Midori Seppa, Silvia Rivas, Lucia Fuentes, Patricia Valverde, Federico Antillón-Klussmann, Mauricio Castellanos, E. Alejandro Sweet-Cordero, Kevin Messacar, John Kurap, Marisol Bustamante, Scott Howard, Bradley Efron, Sandra Luna-Fineman

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Abstract

Background: Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. Methods: This was a retrospective study of Guatemalan children (0–18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001–2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan–Meier analysis estimated the survival. Results: Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. Conclusion: This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.

Original languageEnglish (US)
Article numbere26560
JournalPediatric Blood and Cancer
Volume64
Issue number10
DOIs
StatePublished - Oct 1 2017

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Guatemala
Pediatrics
Treatment Refusal
Neoplasms
Therapeutics
Survival
Survival Analysis
Treatment Failure
Early Diagnosis
Retrospective Studies
Demography
Databases

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Alvarez, E., Seppa, M., Rivas, S., Fuentes, L., Valverde, P., Antillón-Klussmann, F., ... Luna-Fineman, S. (2017). Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatric Blood and Cancer, 64(10), [e26560]. https://doi.org/10.1002/pbc.26560

Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. / Alvarez, Elysia; Seppa, Midori; Rivas, Silvia; Fuentes, Lucia; Valverde, Patricia; Antillón-Klussmann, Federico; Castellanos, Mauricio; Sweet-Cordero, E. Alejandro; Messacar, Kevin; Kurap, John; Bustamante, Marisol; Howard, Scott; Efron, Bradley; Luna-Fineman, Sandra.

In: Pediatric Blood and Cancer, Vol. 64, No. 10, e26560, 01.10.2017.

Research output: Contribution to journalArticle

Alvarez, E, Seppa, M, Rivas, S, Fuentes, L, Valverde, P, Antillón-Klussmann, F, Castellanos, M, Sweet-Cordero, EA, Messacar, K, Kurap, J, Bustamante, M, Howard, S, Efron, B & Luna-Fineman, S 2017, 'Improvement in treatment abandonment in pediatric patients with cancer in Guatemala', Pediatric Blood and Cancer, vol. 64, no. 10, e26560. https://doi.org/10.1002/pbc.26560
Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F et al. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatric Blood and Cancer. 2017 Oct 1;64(10). e26560. https://doi.org/10.1002/pbc.26560
Alvarez, Elysia ; Seppa, Midori ; Rivas, Silvia ; Fuentes, Lucia ; Valverde, Patricia ; Antillón-Klussmann, Federico ; Castellanos, Mauricio ; Sweet-Cordero, E. Alejandro ; Messacar, Kevin ; Kurap, John ; Bustamante, Marisol ; Howard, Scott ; Efron, Bradley ; Luna-Fineman, Sandra. / Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. In: Pediatric Blood and Cancer. 2017 ; Vol. 64, No. 10.
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abstract = "Background: Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. Methods: This was a retrospective study of Guatemalan children (0–18 years) with cancer treated at the Unidad Nacional de Oncolog{\'i}a Pedi{\'a}trica (UNOP), 2001–2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan–Meier analysis estimated the survival. Results: Of 1,789 patients, 21{\%} refused or abandoned treatment. Abandonment decreased from 27{\%} in 2001 to 7{\%} in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. Conclusion: This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.",
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AU - Alvarez, Elysia

AU - Seppa, Midori

AU - Rivas, Silvia

AU - Fuentes, Lucia

AU - Valverde, Patricia

AU - Antillón-Klussmann, Federico

AU - Castellanos, Mauricio

AU - Sweet-Cordero, E. Alejandro

AU - Messacar, Kevin

AU - Kurap, John

AU - Bustamante, Marisol

AU - Howard, Scott

AU - Efron, Bradley

AU - Luna-Fineman, Sandra

PY - 2017/10/1

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N2 - Background: Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. Methods: This was a retrospective study of Guatemalan children (0–18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001–2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan–Meier analysis estimated the survival. Results: Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. Conclusion: This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.

AB - Background: Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. Methods: This was a retrospective study of Guatemalan children (0–18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001–2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan–Meier analysis estimated the survival. Results: Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. Conclusion: This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.

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