UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.
University of North Carolina, Chapel Hill, NC, USA.
Support Care Cancer. 2018 Mar;26(3):967-973. doi: 10.1007/s00520-017-3917-z. Epub 2017 Oct 7.
Lymphoma is the commonest pediatric cancer in sub-Saharan Africa (SSA). Frequent treatment abandonment contributes to suboptimal outcomes. We examined risk factors and reasons for treatment abandonment for this population in Malawi.
We conducted a mixed methods study among children < 18 years old with newly diagnosed lymphoma, prospectively enrolled during 2013-2016. All children received standardized diagnosis and treatment, and were followed for up to 2 years. Treatment abandonment was defined as failure to attend prescribed chemotherapy within 4 weeks, or post-treatment visit within 3 months. Child, guardian, and household characteristics associated with treatment abandonment were assessed. Semi-structured interviews were conducted with primary caregivers of children experiencing treatment abandonment.
Of 121 children with newly diagnosed lymphoma, 72 (60%) had complete information regarding child, guardian, and household characteristics. Of these, 56 (78%) had Burkitt's and 16 (22%) Hodgkin's lymphoma. Forty-nine (68%) were male, median age was 10.6 years (interquartile range [IQR] 7.9-13.0), and 26 (36%) experienced treatment abandonment. Lack of guardian education and travel time ≥ 4 h to clinic were independently associated with treatment abandonment, with adjusted hazard ratio (aHR) 3.8 [95% confidence interval (CI) 1.5-8.9, p = 0.005] and aHR 2.9 (95% CI 1.2-6.9, p = 0.019), respectively. Commonest reasons for treatment abandonment endorsed by 15 guardians were community influence, suboptimal clinic environment, logistical challenges, transport costs, treatment toxicities, loss of hope, alternative healers, and beliefs about cure.
These findings highlight families at risk for treatment abandonment, underlying reasons, and opportunities to improve retention in care for pediatric cancer patients in SSA.
淋巴瘤是撒哈拉以南非洲（SSA）最常见的儿科癌症。频繁的治疗中断导致治疗效果不佳。我们研究了马拉维儿童淋巴瘤患者治疗中断的风险因素和原因。
我们对 2013-2016 年期间新诊断为淋巴瘤的<18 岁儿童进行了一项前瞻性混合方法研究。所有儿童均接受标准化诊断和治疗，并随访 2 年。治疗中断定义为在 4 周内未按规定接受化疗，或在 3 个月内未进行治疗后就诊。评估了与治疗中断相关的儿童、监护人及家庭特征。对经历治疗中断的儿童的主要照顾者进行了半结构化访谈。
在 121 例新诊断为淋巴瘤的儿童中，有 72 例（60%）有完整的儿童、监护人及家庭特征信息。其中，56 例（78%）为伯基特淋巴瘤，16 例（22%）为霍奇金淋巴瘤。49 例（68%）为男性，中位年龄为 10.6 岁（四分位间距[IQR] 7.9-13.0），26 例（36%）经历了治疗中断。监护人缺乏教育和就诊时间≥4 小时与治疗中断独立相关，调整后的危险比（aHR）分别为 3.8（95%CI 1.5-8.9，p=0.005）和 2.9（95%CI 1.2-6.9，p=0.019）。15 位监护人中最常见的治疗中断原因包括社区影响、诊所环境不佳、后勤挑战、交通费用、治疗毒性、失去希望、替代治疗师和对治愈的信念。
这些发现突出了面临治疗中断风险的家庭、潜在原因以及改善撒哈拉以南非洲儿科癌症患者护理保留率的机会。
