National University Hospital, Singapore.
Belfast Health and Social Care Trust, Belfast, United Kingdom.
Pediatr Blood Cancer. 2019 Jun;66(6):e27692. doi: 10.1002/pbc.27692. Epub 2019 Mar 5.
Outcomes of pediatric central nervous system (CNS) tumors in low- to middle-income countries (LMIC) are poorer than their high-income counterparts. Abandonment of therapy is increasingly recognized as a key contributor to this disparity, but has been poorly quantified. We performed a meta-analysis to determine the magnitude of abandonment in pediatric CNS tumors in LMIC, and risk factors and interventions aimed at reducing this.
We searched seven databases for pediatric CNS tumor cohorts followed up from diagnosis and treated in LMIC. All languages were included. Two reviewers independently selected articles and extracted data on abandonment rates (ARs) and predictors. The authors were contacted for additional information.
Of 50 660 publications, 643 in five languages met criteria for full review; 131 met analysis inclusion criteria. ARs were not reported in the majority, and a small number were available from the authors. Available ARs ranged from 0% to 59%, from 38 studies (2497 children in 14 countries), and these were quantitatively analyzed. Lower-middle-income countries had higher ARs than upper-middle-income countries (27%, 95% confidence interval [CI] 20%-36% vs 9%, 95% CI 6%-14%, P < 0.0001), with significant heterogeneity within each (LMIC I = 78%, P < 0.00001, UMIC I = 85%, P < 0.00001). Common predictors for abandonment included distance to treatment centers, financial hardship, and prognostic misconceptions.
In LMICs, ARs are highest in lower-MICs. However, the paucity of published data limits further evaluation. Given the increasing burden of pediatric CNS tumors in LMIC, addressing deficits in abandonment reporting is critical. Consistent reporting is needed for developing interventions to improve outcomes.
中低收入国家（LMIC）儿科中枢神经系统（CNS）肿瘤的治疗结果不如高收入国家。越来越多的人认识到放弃治疗是造成这种差异的一个关键因素，但这一因素的量化研究却很少。我们进行了一项荟萃分析，以确定中低收入国家儿科 CNS 肿瘤的放弃治疗率（AR）及其危险因素和干预措施。
我们在七个数据库中搜索了在中低收入国家诊断和治疗的儿科 CNS 肿瘤队列的研究。所有语言均包含在内。两名评审员独立筛选文章并提取有关 AR 和预测因素的数据。作者被联系以获取更多信息。
在 50660 篇文献中，有 643 篇来自五种语言的文献通过了全面审查标准；131 篇符合分析纳入标准。大多数研究未报告 AR，少数研究可从作者处获得。可获得的 AR 范围为 0%至 59%，来自 38 项研究（14 个国家的 2497 名儿童），并对这些数据进行了定量分析。中低收入国家的 AR 高于中高收入国家（27%，95%置信区间[CI]20%-36% vs 9%，95%CI6%-14%，P<0.0001），每个收入组内均存在显著异质性（中低收入国家 I=78%，P<0.00001，中高收入国家 I=85%，P<0.00001）。常见的放弃治疗预测因素包括距治疗中心的距离、经济困难和预后误解。
在中低收入国家，中低收入国家的 AR 最高。然而，发表数据的缺乏限制了进一步的评估。鉴于中低收入国家儿科 CNS 肿瘤的负担不断增加，解决放弃治疗报告中的缺陷至关重要。需要进行一致的报告，以制定改善结局的干预措施。
