Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, and National Children's Medical Center, Shanghai, China.
Department of Hematology/Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.
Arch Dis Child. 2019 Jun;104(6):522-529. doi: 10.1136/archdischild-2018-316181. Epub 2019 Jan 31.
Before 2003, most children with acute lymphoblastic leukaemia (ALL) abandoned treatment, with only approximately 30% treated in China. With the development of national insurance for underprivileged patients, we assessed the current frequency and causes of treatment abandonment among patients with ALL who were enrolled in the Chinese Children's Cancer Group ALL protocol between 2015 and 2016.
Demographic, clinical and laboratory data on patients who abandoned treatment, as well as economic and sociocultural data of their families were collected and analysed. General health-related statistics were retrieved from publicly accessible databanks maintained by the Chinese government.
At a median follow-up of 119 weeks, 83 (3.1%, 95% CI 2.5% to 3.8%) of the 2641 patients abandoned treatment. Factors independently associated with abandonment included standard/high-risk ALL (OR 2.62, 95% CI 1.43 to 4.77), presence of minimal residual disease at the end of remission induction (OR 3.57, 95% CI 1.90 to 6.74) and low-income economic region (OR 3.7, 95% CI 1.89 to 7.05). According to the family members, economic constraints (50.6%, p=0.0001) were the main reason for treatment abandonment, followed by the belief of incurability, severe side effects and concern over late complications.
The rate of ALL treatment abandonment has been greatly reduced in China. Standard/high-risk ALL, residence in a low-income region and economic difficulties were associated with treatment abandonment.
ChiCTR-IPR-14005706, pre-results.
2003 年以前，大多数急性淋巴细胞白血病（ALL）患儿放弃治疗，中国仅有约 30%的患儿接受治疗。随着国家针对贫困患者医疗保险的发展，我们评估了 2015 年至 2016 年中国儿童癌症组 ALL 方案入组的 ALL 患儿中目前放弃治疗的频率和原因。
收集并分析放弃治疗患儿的人口统计学、临床和实验室数据，以及其家庭的经济和社会文化数据。一般健康相关统计数据取自中国政府公开可访问的数据库。
在中位随访 119 周时，2641 例患儿中有 83 例（3.1%，95%CI 2.5%至 3.8%）放弃治疗。与放弃治疗独立相关的因素包括标准/高危 ALL（OR 2.62，95%CI 1.43 至 4.77）、缓解诱导期末微小残留病阳性（OR 3.57，95%CI 1.90 至 6.74）和低经济收入地区（OR 3.7，95%CI 1.89 至 7.05）。根据患儿家属的说法，经济困难（50.6%，p=0.0001）是放弃治疗的主要原因，其次是认为无法治愈、严重副作用和担心晚期并发症。
中国 ALL 患儿放弃治疗的比例已大幅降低。标准/高危 ALL、居住在低收入地区和经济困难与放弃治疗相关。
ChiCTR-IPR-14005706，预注册结果。
