Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
Support Care Cancer. 2020 Feb;28(2):917-924. doi: 10.1007/s00520-019-04859-1. Epub 2019 Jun 7.
Survival of childhood cancer in high-income countries is approximately 80%, whereas in low-income countries, it is less than 10%. Limited access to health insurance in low-income settings may contribute to poor survival rates. This study evaluates the influence of health insurance status on childhood cancer treatment in a Kenyan academic hospital.
This was a retrospective study. All children diagnosed with a malignancy from 2010 until 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were abstracted from patient charts.
Of 280 patients, 34% abandoned treatment, 19% died, and 18% had progressive or relapsed disease resulting in 29% event-free survival. The majority of patients (65%) did not have health insurance at diagnosis. Treatment results differed significantly between patients with different health insurance status at diagnosis; 37% of uninsured versus 28% of insured patients abandoned treatment, and 24% of uninsured versus 37% of insured patients had event-free survival. The event-free survival estimate was significantly higher for patients with health insurance at diagnosis compared with those without (P = 0.004). Of patients without health insurance at diagnosis, 77% enrolled during treatment. Among those patients who later enrolled in health insurance, frequency of progressive or relapsed disease and deaths was significantly lower (P = 0.013, P < 0.001, respectively), while the event-free survival estimate was significantly higher (P < 0.001) compared with those who never enrolled.
Childhood cancer event-free survival was 29% at a Kenyan hospital. Children without health insurance had significant lower chance of event-free survival. Childhood cancer treatment outcomes could be ameliorated by strategies that prevent treatment abandonment and improve access to health insurance.
在高收入国家，儿童癌症的存活率约为 80%，而在低收入国家，这一比例不到 10%。在低收入环境中，获得健康保险的机会有限，可能导致存活率较低。本研究评估了肯尼亚一家学术医院中健康保险状况对儿童癌症治疗的影响。
这是一项回顾性研究。纳入了 2010 年至 2012 年期间被诊断患有恶性肿瘤的所有儿童。从患者病历中提取治疗结果和诊断时的健康保险状况数据。
在 280 名患者中，34%的患者放弃了治疗，19%的患者死亡，18%的患者疾病进展或复发，导致 29%的患者无事件生存。大多数患者（65%）在诊断时没有健康保险。诊断时健康保险状况不同的患者治疗结果差异显著；未参保患者中 37%放弃治疗，而参保患者中为 28%；未参保患者中 24%无事件生存，而参保患者中为 37%。与未参保患者相比，诊断时参保的患者无事件生存估计显著更高（P=0.004）。在未参保的患者中，77%在治疗期间参保。对于后来参保的患者，疾病进展或复发和死亡的频率显著降低（P=0.013，P<0.001），而无事件生存估计显著更高（P<0.001）。
肯尼亚医院儿童癌症的无事件生存率为 29%。没有健康保险的儿童无事件生存的机会显著降低。通过防止治疗中断和改善健康保险获取的策略，可以改善儿童癌症的治疗结果。
