Stoeter Ole, Mezger Nikolaus C S, Koenig Tamara, Chokunonga Eric, Tessema Girum, Damise Adugna Fekadu, Makouanzi Alda Stevy, Majaliwa Esther, Ivanga Mahine, Kamate Bakarou, Gnahatin Franck, Nambooze Sarah, Ekanem Ima-Obong A, Bernig Toralf, Liu Biying, Gupta Sumit, Kantelhardt Eva Johanna
Global and Planetary Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Zimbabwe National Cancer Registry, Harare, Zimbabwe.
JCO Glob Oncol. 2025 Feb;11:e2400137. doi: 10.1200/GO.24.00137. Epub 2025 Feb 6.
The number of patients with childhood cancer (CC) in sub-Saharan Africa is expected to rise over the coming years. According to the WHO Initiative for Childhood Cancer, access to care is crucial and must be guided by the needs of patients and their families. Our study explored barriers to CC treatment from a patient's perspective to guide the health care providers.
From February to September 2021, we conducted a multinational cross-sectional study with a sample from nine population-based cancer registries in nine sub-Saharan countries. Inclusion criteria comprised a cancer diagnosis according to the International Classification of Childhood Cancer, age 0-19 years, and year of diagnosis 2017-2019. A questionnaire was administered asking families about self-perceived barriers accessing surgery, radiotherapy, and chemotherapy. To assess associated factors, we conducted a multivariable regression analysis presenting the results as odds ratios (ORs).
A total of 224 patients with CC was included. The fear of treatment effects and the perceived (poor) health of the child were named most frequently as barriers for all treatment modalities (78.9% and 75.5%, respectively). For chemotherapy, respondents who indicated themselves as rich had lower odds of perceiving the (poor) health of the child as a barrier (OR, 0.06 [95% CI, 0.01 to 0.36]). For radiotherapy, long waiting time and (limited) availability in the country were more commonly barriers (OR, 7.53 [95% CI, 3.38 to 16.78]; OR, 11.11 [95% CI, 2.04 to 60.46], respectively) than for chemotherapy.
Despite known barriers such as the availability of therapy, our study additionally indicates the importance of the patients' and families' perceptions of the disease and its treatment. Further expanding measures of social support for affected families should be regarded as one of the main pillars to assure access to care.
预计在未来几年里，撒哈拉以南非洲地区儿童癌症（CC）患者的数量将会增加。根据世界卫生组织儿童癌症倡议，获得医疗服务至关重要，且必须以患者及其家庭的需求为导向。我们的研究从患者的角度探讨了CC治疗的障碍，以指导医疗服务提供者。
2021年2月至9月，我们进行了一项跨国横断面研究，样本来自撒哈拉以南九个国家的九个基于人群的癌症登记处。纳入标准包括根据国际儿童癌症分类法确诊为癌症、年龄在0至19岁之间以及诊断年份为2017年至2019年。我们发放了一份问卷，询问家庭关于获得手术、放疗和化疗的自我感知障碍。为了评估相关因素，我们进行了多变量回归分析，并将结果以比值比（OR）的形式呈现。
共纳入了224例CC患者。对治疗效果的恐惧以及认为孩子（健康状况不佳）是所有治疗方式最常被提及的障碍（分别为78.9%和75.5%）。对于化疗，自认为富有的人将孩子（健康状况不佳）视为障碍的几率较低（OR为0.06 [95% CI，0.01至0.36]）。对于放疗，与化疗相比，在该国等待时间长和（供应）有限更常成为障碍（OR分别为7.53 [95% CI，3.38至16.78]；OR为11.11 [95% CI，2.04至60.46]）。
尽管存在诸如治疗可及性等已知障碍，但我们的研究还表明了患者及其家庭对疾病及其治疗的认知的重要性。进一步扩大对受影响家庭的社会支持措施应被视为确保获得医疗服务的主要支柱之一。
