Martijn Hugo A, Njuguna Festus, Olbara Gilbert, Langat Sandra, Skiles Jodi, Martin Stephen, Vik Terry, van de Ven Peter M, Kaspers Gertjan Jl, Mostert Saskia
Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
BMJ Paediatr Open. 2017 Aug 11;1(1):e000149. doi: 10.1136/bmjpo-2017-000149. eCollection 2017.
Non-Hodgkin's lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes.
This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected.
Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063).
Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.
非霍奇金淋巴瘤（NHL）是撒哈拉以南非洲最常见的儿童恶性肿瘤。在高收入国家，NHL的生存率高于80%。本研究探讨了撒哈拉以南低收入国家肯尼亚儿童NHL的治疗结果，以及诊断时的健康保险状况与治疗结果之间的关联。
这是一项回顾性病历研究。纳入了2010年、2011年和2012年所有诊断为NHL的儿童。收集了治疗结果和诊断时健康保险状况的数据。
在所有63例NHL患者中，35%放弃治疗，22%疾病进展或复发，14%死亡，29%无事件生存。大多数患者（73%）在诊断时没有健康保险。诊断时有无健康保险的儿童治疗结果有显著差异（p = 0.005）。诊断时有健康保险的儿童最可能的治疗结果是无事件生存（53%），而诊断时没有健康保险的儿童则是放弃治疗（44%）。未参保儿童与参保儿童相比，治疗失败的粗风险比为3.1（95%可信区间1.41至6.60，p = 0.005）。诊断时有健康保险的儿童无事件生存估计值显著高于诊断时无健康保险的患者（p = 0.003）。诊断时的疾病分期被确定为该关联的一个混杂因素（调整后风险比 = 2.4，95%可信区间0.95至6.12，p = 0.063）。
与高收入国家相比，肯尼亚NHL儿童的生存率要低得多。放弃治疗是治疗失败的最常见原因。诊断时的健康保险与更好的治疗结果和生存相关。
