Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi.
Academy Outreach and Department of Solid Tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.
Pediatr Blood Cancer. 2022 Dec;69(12):e29899. doi: 10.1002/pbc.29899. Epub 2022 Jul 23.
Treatment abandonment is a common cause of treatment failure in low-income countries (LIC). We implemented a comprehensive package of interventions aiming to enable all families to complete the treatment of their child. The objective of this study was to evaluate the impact of those interventions.
In this prospective and historically controlled study, we included all children younger than 16 years with a newly diagnosed common and curable cancer type (acute lymphoblastic leukaemia [ALL], Hodgkin disease, Wilms tumour, retinoblastoma and Burkitt lymphoma) admitted to the Queen Elizabeth Central Hospital in Blantyre, Malawi, between 1 June 1 2019 and 1 June 1 2020. Interventions to enable treatment completion included full funding of costs to the family (treatment, transport, accommodation and food in the hospital) and tracking of patients if they did not attend treatment appointments. The outcomes of patients were compared with those of a similar historical cohort.
The intervention cohort of 150 patients were compared to 264 historical control patients. Treatment abandonment decreased significantly from 19% (49/264) to 7% (10/150) (p < .001). The proportion of patients with Wilms tumour, retinoblastoma or ALL alive without evidence of disease at the end of treatment increased from 38% (57/149) to 53% (44/83) (p = .03).
A simple and relatively low-cost comprehensive intervention package with no costs for families, significantly decreased treatment abandonment. This strategy may increase survival of children with common and curable cancers in LIC, especially when coupled with improvements in access to treatment and quality of treatment, including supportive care.
在低收入国家（LIC），治疗中断是治疗失败的常见原因。我们实施了一整套干预措施，旨在使所有家庭都能完成儿童的治疗。本研究的目的是评估这些干预措施的影响。
在这项前瞻性的历史对照研究中，我们纳入了所有 2019 年 6 月 1 日至 2020 年 6 月 1 日期间在马拉维布兰太尔的伊丽莎白女王中央医院新诊断为常见且可治愈癌症类型（急性淋巴细胞白血病[ALL]、霍奇金病、肾母细胞瘤、视网膜母细胞瘤和伯基特淋巴瘤）的 16 岁以下儿童。为使治疗完成而采取的干预措施包括向家庭全额报销治疗、交通、住宿和医院餐饮费用，如果患者未按预约接受治疗，还将对其进行跟踪。将患者的结局与类似的历史队列进行比较。
干预组 150 例患者与 264 例历史对照组患者进行了比较。治疗中断率从 19%（49/264）显著下降至 7%（10/150）（p<0.001）。治疗结束时无疾病证据且存活的 Wilms 瘤、视网膜母细胞瘤或 ALL 患者比例从 38%（57/149）增加到 53%（44/83）（p=0.03）。
一套简单且相对低成本的综合干预措施，无需家庭承担费用，显著降低了治疗中断率。这种策略可能会提高 LIC 中常见和可治愈癌症患儿的生存率，尤其是当结合改善治疗机会和治疗质量（包括支持性护理）时。
