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Mutua D, Omotola A, Bonilla M, Bhakta N, Friedrich P, Wata D, Muma SN, Ganey M, Muriithi C, Mwangi M, Maina AK, Libes J. Implementation of a formalized evaluation and planning tool to improve pediatric oncology outcomes in Kenya. Pediatr Blood Cancer 2023; 70:e30657. [PMID: 37690982 DOI: 10.1002/pbc.30657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Survival from pediatric cancers in low middle-income countries is often very low compared to that of high-income countries due to multifactorial etiologies, including late presentation, delayed diagnosis, difficulty with accessing healthcare, drug unavailability, and treatment abandonment. The St. Jude Pediatric Oncology Facility Integrated Local Evaluation Tool (PrOFILE) was developed to map and evaluate childhood cancer healthcare delivery in individual institutions and entire countries, identifying the strengths and weaknesses, as well as opportunities for advancement of care. PROCEDURE Using the PrOFILE self-assessment tool, selected Kenyan pediatric oncology facilities entered data into 12 modules: national context, facility and local context, finances and resources, personnel, service capacity, service integration, diagnostics, chemotherapy, supportive care, surgery, radiation therapy, and patients and outcomes. These modules are grouped into five specific components, including Context, Workforce, Diagnostics, Therapy, and Patients and Outcomes. The St. Jude PrOFILE team analyzed the data and organized the first hybrid workshop, containing both in-person and virtual components. RESULTS Multidisciplinary stakeholders prioritized recommendations for improving care and developed smart objectives to accomplish identified goals over the following 2 years. Strengths and weaknesses of conducting a hybrid global workshop were identified. CONCLUSIONS We demonstrated successful use of the PrOFILE tool to conduct a hybrid workshop and identify strategies to improve pediatric oncology care in Kenya. The voluntarily structured work groups will methodically aim to achieve outcome-oriented goals moving forward.
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Affiliation(s)
| | - Ayomide Omotola
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Miguel Bonilla
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nickhill Bhakta
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Paola Friedrich
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David Wata
- Division of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Michael Ganey
- Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Loma Linda University School of Medicine, California, USA
| | | | - Martin Mwangi
- National Cancer Institute of Kenya, Ministry of Health, Nairobi, Kenya
| | | | - Jaime Libes
- Department of Pediatric Hematology-Oncology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
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2
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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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3
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Langat S, Njuguna F, Olbara G, Martijn H, Sieben C, Haverkort M, Njenga D, Vik TA, Kaspers G, Mostert S. Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya. Support Care Cancer 2023; 31:467. [PMID: 37452971 PMCID: PMC10349750 DOI: 10.1007/s00520-023-07913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Few governments in low and middle-income countries (LMIC) have responded favourably to the international plea for Universal Health Coverage. Childhood cancer survival in LMIC is often below 20%. Limited health-insurance coverage may contribute to this poor survival. Our study explores the influence of health-insurance status on childhood cancer treatment outcomes in a Kenyan academic hospital. METHODS This was a retrospective medical records review of all children diagnosed with cancer at Moi Teaching and Referral Hospital between 2010 and 2016. Socio-demographic and clinical data was collected using a structured data collection form. Fisher's exact test, chi-squared test, Kaplan-Meier method, log-rank test and Cox proportional hazard model were used to evaluate relationships between treatment outcomes and patient characteristics. Study was approved by Institutional Research Ethics Committee. FINDINGS From 2010-2016, 879 children were newly diagnosed with cancer. Among 763 patients whose records were available, 28% abandoned treatment, 23% died and 17% had progressive/relapsed disease resulting in 32% event-free survival. In total 280 patients (37%) had health-insurance at diagnosis. After active enrolment during treatment, total health-insurance registration level reached 579 patients (76%). Treatment outcomes differed by health-insurance status (P < 0.001). The most likely treatment outcome in uninsured patients was death (49%), whereas in those with health-insurance at diagnosis and those who enrolled during treatment it was event-free survival (36% and 41% respectively). Overall survival (P < 0.001) and event-free survival (P < 0.001) were higher for insured versus uninsured patients. The hazard-ratio for treatment failure was 0.30 (95% CI:0.22-0.39; P < 0.001) for patients insured at diagnosis and 0.32 (95% CI:0.24-0.41; P < 0.001) for patients insured during treatment in relation to those without insurance. INTERPRETATION Our study highlights the need for Universal Health Coverage in LMIC. Children without health-insurance had significantly lower survival. Childhood cancer treatment outcomes can be ameliorated by strategies that improve health-insurance access.
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Affiliation(s)
- Sandra Langat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Hugo Martijn
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Cenne Sieben
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Moniek Haverkort
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dennis Njenga
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
- Department of Pediatrics, Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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4
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Cotache-Condor C, Kantety V, Grimm A, Williamson J, Landrum KR, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2023; 70:e30175. [PMID: 36579761 DOI: 10.1002/pbc.30175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
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Affiliation(s)
| | - Vinootna Kantety
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama, USA
| | | | - Kelsey R Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
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5
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Severance TS, Njuguna F, Olbara G, Kugo M, Langat S, Mostert S, Klootwijk L, Skiles J, Coven SL, Overholt KM, Kaspers G, Vik TA. An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Pediatr Blood Cancer 2022; 69:e29768. [PMID: 35593641 DOI: 10.1002/pbc.29768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Western Kenya is home to approximately 24 million people, with 10 million children under the age of 15 years.1 Based on estimates of cancer incidence in similar populations from around the world, approximately 1500 patients should be diagnosed with pediatric cancer each year. This article describes the international collaboration that investigates potential barriers preventing the effective diagnosis of pediatric patients with cancer. METHODS Here, we describe a multidisciplinary and sequential approach to better evaluate the complex factors affecting the lack of appropriate diagnosis of pediatric cancer in Western Kenya. RESULTS Internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75%-80% of patients go undiagnosed and do not receive treatment. Following our screening process at a local referring hospital, 41 malaria slides demonstrated both morphologic and genetic evidence of leukemia. Knowledge assessments of local providers at referring institutions suggested a lack of education and training as the factors that contribute to lower rates of diagnosis. DISCUSSION Through a multi-step approach, our teams were better able to isolate potential issues impeding the appropriate and timely diagnosis of pediatric cancer in Kenya.
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Affiliation(s)
- Tyler S Severance
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | | | | | - Maureen Kugo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Saskia Mostert
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Larissa Klootwijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jodi Skiles
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Scott L Coven
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Kathleen M Overholt
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
| | - Terry A Vik
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA.,Moi Teaching and Referral Hospital, Eldoret, Kenya
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6
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Mirutse MK, Tolla MT, Memirie ST, Palm MT, Hailu D, Abdi KA, Buli ED, Norheim OF. The magnitude and perceived reasons for childhood cancer treatment abandonment in Ethiopia: from health care providers' perspective. BMC Health Serv Res 2022; 22:1014. [PMID: 35941600 PMCID: PMC9361525 DOI: 10.1186/s12913-022-08188-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Treatment abandonment is one of major reasons for childhood cancer treatment failure and low survival rate in low- and middle-income countries. Ethiopia plans to reduce abandonment rate by 60% (2019–2023), but baseline data and information about the contextual risk factors that influence treatment abandonment are scarce. Methods This cross-sectional study was conducted from September 5 to 22, 2021, on the three major pediatric oncology centers in Ethiopia. Data on the incidence and reasons for treatment abandonment were obtained from healthcare professionals. We were unable to obtain data about the patients’ or guardians’ perspective because the information available in the cancer registry was incomplete to contact adequate number of respondents. We used a validated, semi-structured questionnaire developed by the International Society of Pediatric Oncology Abandonment Technical Working Group. We included all (N = 38) health care professionals (physicians, nurses, and social workers) working at these centers who had more than one year of experience in childhood cancer service provision (a universal sampling and 100% response rate). Results The perceived mean abandonment rate in Ethiopia is 34% (SE 2.5%). The risk of treatment abandonment is dependent on the type of cancer (high for bone sarcoma and brain tumor), the phase of treatment and treatment outcome. The highest risk is during maintenance and treatment failure or relapse for acute lymphoblastic leukemia, and during pre- or post-surgical phase for Wilms tumor and bone sarcoma. The major influencing risk factors in Ethiopia includes high cost of care, low economic status, long travel time to treatment centers, long waiting time, belief in the incurability of cancer and poor public awareness about childhood cancer. Conclusions The perceived abandonment rate in Ethiopia is high, and the risk of abandonment varies according to the type of cancer, phase of treatment or treatment outcome. Therefore, mitigation strategies to reduce the abandonment rate should include identifying specific risk factors and prioritizing strategies based on their level of influence, effectiveness, feasibility, and affordability. Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08188-8.
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Affiliation(s)
| | - Mieraf Taddesse Tolla
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Ole F Norheim
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
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7
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Uittenboogaard A, Njuguna F, Mostert S, Langat S, van de Velde ME, Olbara G, Vik TA, Kaspers GJL. Outcomes of Wilms tumor treatment in western Kenya. Pediatr Blood Cancer 2022; 69:e29503. [PMID: 34908225 DOI: 10.1002/pbc.29503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVES Wilms tumor (WT) is a curable type of cancer with 5-year survival rates of over 90% in high-income countries, whereas this is less than 50% in low- and middle-income countries. We assessed treatment outcomes of children with WT treated at a large Kenyan teaching and referral hospital. DESIGN/METHODS We conducted a retrospective record review of children diagnosed with WT between 2013 and 2016. Treatment protocol consisted of 6 weeks of preoperative chemotherapy and surgery, and 4-18 weeks of postoperative chemotherapy depending on disease stage. Probability of event-free survival (pEFS) and overall survival (pOS) was assessed using Kaplan-Meier method with Cox regression analysis. Competing events were analyzed with cumulative incidences and Fine-Gray regression analysis. RESULTS Of the 92 diagnosed patients, 69% presented with high-stage disease. Two-year observed EFS and OS were, respectively, 43.5% and 67%. Twenty-seven percent of children died, 19% abandoned treatment, and 11% suffered from progressive or relapsed disease. Patients who were diagnosed in 2015-2016 compared to 2013-2014 showed higher pEFS. They less often had progressive or relapsed disease (p = .015) and borderline significant less often abandonment of treatment (p = .09). Twenty-nine children received radiotherapy, and 2-year pEFS in this group was 86%. CONCLUSION Outcome of children with WT improved over the years despite advanced stage at presentation. Survival probabilities of patients receiving comprehensive therapy including radiation are approaching those of patients in high-income countries. Additional improvement could be achieved by ensuring that patients receive all required treatment and working on earlier diagnosis strategies.
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Affiliation(s)
- Aniek Uittenboogaard
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sandra Langat
- Department of Child Health and Pediatrics, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mirjam E van de Velde
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Terry A Vik
- Pediatric Hematology - Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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8
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Tilly AE, Ellis GK, Chen JS, Manda A, Salima A, Mtangwanika A, Tewete B, Kaimila B, Kasonkanji E, Kayira E, Chikasema M, Nyirenda R, Bingo S, Chiyoyola S, Seguin R, Gopal S, Zuze T, Tomoka T, Westmoreland KD. Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment. JCO Glob Oncol 2022; 8:e2100315. [PMID: 35175832 PMCID: PMC8863121 DOI: 10.1200/go.21.00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/15/2021] [Accepted: 01/12/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi. METHODS We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience. RESULTS Both pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%). CONCLUSION Standardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.
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Affiliation(s)
- Alyssa E. Tilly
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jane S. Chen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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9
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Jestico ECL, Schutz SE, Finlay TMD, Appleton JV. How 'significant others' may support parents with decision-making about their child's cancer care: An integrative literature review. J Clin Nurs 2022; 32:1821-1840. [PMID: 35040523 DOI: 10.1111/jocn.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care. BACKGROUND Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others. METHOD An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method. RESULTS Twenty-six articles were included in the review. Two overarching themes were identified. Theme 1-Dimensions of Decision-Making support-included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2-Expectations of Decision-Making support-identified that parents' expectations of their own role, and the role of their significant others, affected how decision-making was supported. CONCLUSIONS Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours. RELEVANCE TO CLINICAL PRACTICE Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents' support needs.
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Affiliation(s)
| | - Susan E Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Teresa M D Finlay
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Jane V Appleton
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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10
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Handayani K, Susilawati D, Sutaryo, Mulatsih S, Kaspers GJL, Mostert S, Sitaresmi M. Health-care providers’ perception and communication about traditional and complementary medicine in childhood cancer in Indonesia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Olbara G, van der Wijk T, Njuguna F, Langat S, Mwangi H, Skiles J, Vik TA, Kaspers GJL, Mostert S. Childhood acute lymphoblastic leukemia treatment in an academic hospital in Kenya: Treatment outcomes and health-care providers' perspectives. Pediatr Blood Cancer 2021; 68:e29366. [PMID: 34569156 DOI: 10.1002/pbc.29366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early deaths and treatment nonadherence are major reasons for low childhood acute lymphoblastic leukemia (ALL) survival in low- and middle-income countries. This study assessed treatment outcomes of children presenting with ALL and evaluated perspectives of health-care providers (HCP) on ALL treatment at a Kenyan academic hospital. METHODS This was a combined retrospective medical records and cross-sectional questionnaire study. Treatment outcomes of 136 children diagnosed with ALL between 2010 and 2016 were collected. Questionnaires were completed by 245 HCP (response rate, 86%) between September and October 2016. RESULTS Childhood ALL treatment outcomes were death (30%), progressive or relapsed disease (26%), abandonment (24%), and event-free survival (20%). Of all deaths, 80% were early deaths (prior or during induction), whereas 20% occurred in remission. Probability of event-free survival at three years was 18%. Only 57% of HCP believed childhood ALL can be cured, with more doctors (96%) than other HCP (45%) believing in curability of ALL (P < 0.001). The majority of HCP (96%) thought that experienced doctors should put more time and effort into making parents understand the diagnosis and necessity to complete treatment. According to HCP, reasons for protocol nonadherence included parental financial difficulties (94%) and use of alternative treatment (79%). CONCLUSIONS Event-free survival for ALL in Kenya is low. The primary reason for treatment failure is early death from treatment-related complications. More efforts should be directed toward improving supportive care strategies. In the opinion of HCPs, improved communication with parents and supervision of junior staff will improve ALL treatment outcomes.
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Affiliation(s)
- Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Thyra van der Wijk
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Henry Mwangi
- Department of Health Information Management, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terrry A Vik
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya.,Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gertjan J L Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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12
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Abstract
BACKGROUND A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. OBJECTIVE The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. METHODS We used Rodgers' evolutionary method and articles published between January 2013 and December 2020. RESULTS We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. CONCLUSIONS Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. IMPLICATIONS FOR PRACTICE Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.
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13
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Li W, Wang X, Yang Y, Zhao L, Lin D, Wang J, Zhu Y, Chen C, Liu Z, Wu X, Zhang X, Wang R, Li R, Ting DSW, Huang W, Lin H. The associations of population mobility in HIV disease severity and mortality rate in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:315. [PMID: 33708942 PMCID: PMC7944320 DOI: 10.21037/atm-20-4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Human immunodeficiency virus (HIV) infection has become a chronic disease and attracted public attention globally. Population migration was considered hindering the control and management of HIV infection, but limited studies have explored how population mobility could influence the development of HIV-related complications and overall prognosis. Methods We enrolled hospitalized HIV patients in this cross-sectional study between January 1, 2006, and December 31, 2016. We extracted demographic, hospitalization, and patient diagnosis data. Patients were divided into three groups according to the population type: (I) resident of Guangzhou City (local resident); (II) migrant outside of Guangzhou City but within Guangdong Province (migrant within the province); and (III) migrant outside of Guangdong Province (migrant outside the province). To represent the prognosis of HIV, in-hospital death was defined as the worst outcome, whereas vision-related events were considered moderate-to-severe complications. Logistic regression models were used to analyze factors influencing the prognosis of HIV. Results Eight thousand and six hundred thirty-one inpatients (14,954 cases) were enrolled. The overall mortality was 7.9%, decreasing from 21.5% in 2006 to 3.8% in 2016. The prevalence of vision-related events was 14.4% between 2015 and 2016. Compared to local patients, migrant patients (within and outside the province) were younger, had significantly less access to health insurance, fewer hospitalization admissions, longer hospital stays, and a higher proportion of physical work (P<0.01). Furthermore, they had a higher prevalence of vision-related events (16.2% and 17.4% in migrant patients within the province and outside the province, respectively vs. 9.5%) and infectious diseases, but lower in-hospital mortality (5.9% and 7.0% vs. 12.3%) than local patients. Migrants correlated negatively with in-hospital death [odds ratio (OR) 95% CI, 0.37 (0.29–0.48) and 0.52 (0.40–0.68)] but correlated positively with vision-related events [OR (95% CI), 2.08 (1.54–2.80) and 2.03 (1.47–2.80)]. Conclusions Migrant patients have significantly poorer access to health insurance, with an increased risk of developing moderate-to-severe HIV infection but a decreased risk of in-hospital death, indicating a trend toward withdrawing treatment in migrant patients when they have advanced diseases. Managements such as optimizing access to health insurance and improving follow-up visits for HIV infection should be considered in the context of the population mobility of HIV patients.
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Affiliation(s)
- Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
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14
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Jiang C, Cai S, Duan C, Xu N, Zhou Y, Peng X, Ma X. Analysis of treatment cost for neuroblastoma to the family: a single-center cross-sectional study in China. J Med Econ 2020; 23:961-966. [PMID: 32568600 DOI: 10.1080/13696998.2020.1786392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neuroblastoma (NB) is notorious in childhood cancer because of its high incidence and poor prognosis. The Children's Oncology Group reported that the 3-year OS in the high-risk (HR) group is 50%, and the HR-NB with bone marrow metastasis in our center is 43.1%. Thousands of families in China suffer from the cost of NB, but the true costs of therapy are unknown; to date, no study has ever performed a detailed therapy costs analysis for NB. The objective of this study was to assess the economic burden of NB treatment in children to the family, to ultimately reduce related expenses for patients and promote the establishment of NB management policy. MATERIALS AND METHODS Data in this cross-sectional study were collected via questionnaires completed by parents at the outpatient clinic and was verified via a computer system. Therapy costs of children with NB of differing risks were analyzed through descriptive statistics (1 CNY ≈ 0.1412 USD). RESULTS Median direct medical costs of low risk (LR), middle risk (MR), and HR NB during treatment were 180.0 (120.0, 300.0), 200.0 (166.0, 300.0), and 650.0 (415.5, 850.0) thousand Chinese yuan (CNY), respectively. Direct non-medical costs including transportation, food, and accommodation were 60.0 (37.0, 100.0), 80.0 (60.0, 120.0), and 100.0 (80.0, 157.5) thousand CNY in the LR, MR, and HR groups, respectively. Additionally, parents accrued work absences to attend treatment, and lost a total of 100.0 (50.0, 150.0) thousand CNY in indirect costs. LIMITATIONS Families whose children had relapsed or died were excluded from this analysis and therefore limited the conclusions drawn. Parents were asked to recall costs since initial diagnosis (1-6 years in the past), but this extended time period may have introduced recall bias. CONCLUSIONS Direct non-medical and indirect costs play an important role in the total treatment costs of NB. Children with NB treated in local hospitals and followed up in hospital specialized in childhood oncology may save many unnecessary expenses. China's healthcare system should establish mechanisms and provide financial support for children with NB.
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Affiliation(s)
- Chiyi Jiang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chao Duan
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Xu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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15
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Langat S, Njuguna F, Kaspers G, Mostert S. Health insurance coverage for vulnerable children: two HIV orphans with Burkitt lymphoma and their quest for health insurance coverage in Kenya. BMJ Case Rep 2020; 13:13/8/e230508. [PMID: 32843443 DOI: 10.1136/bcr-2019-230508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The United Nations and WHO have summoned governments from low-income and middle-income countries to institute universal health coverage and thereby improve their population's healthcare access and outcomes. Until now, few countries responded favourably to this international plea. The HIV/AIDS epidemic, a major global public health challenge, resulted in over 11 million orphans in sub-Saharan Africa. Extended families have taken responsibility for more than 90% of these children. HIV orphans are likely to be poorer and less healthy. Burkitt lymphoma is the most common childhood cancer in sub-Saharan Africa. If orphans need lifesaving chemotherapy, appointing legal guardians becomes necessary to access health insurance. However, rules and regulations involved may be unclear and costly. This hinders its access for poor families who need it most. Uninsured children risk hospital detention over unpaid medical bills and have lower survival. Our case report depicts the quest for health insurance coverage of two HIV orphans with Burkitt lymphoma in Kenya.
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Affiliation(s)
- Sandra Langat
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Festus Njuguna
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gertjan Kaspers
- Department of Pediatric Oncology-Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands .,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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16
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Communication about Traditional Complementary and Alternative Medicine (TCAM) in childhood cancer: A comparison between Dutch and Indonesian health-care providers at academic hospitals. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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17
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Challinor JM, Day SW, Afungchwi GM, Alqudimat MR. Pediatric Oncology Nursing Research in Low- and Middle-Income Countries. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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18
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Koffi KG, Silué DA, Laurent C, Boidy K, Koui S, Compaci G, Adeba ZH, Kamara I, Botty RP, Bognini AS, Sanogo I, Despas F, Laurent G. AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study. BMC Cancer 2019; 19:1247. [PMID: 31870438 PMCID: PMC6929302 DOI: 10.1186/s12885-019-6478-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.
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Affiliation(s)
- K G Koffi
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire.
| | - D A Silué
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - C Laurent
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - K Boidy
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - S Koui
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - G Compaci
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - Z H Adeba
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - I Kamara
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - R P Botty
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - A S Bognini
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - I Sanogo
- Hematology Teaching Hospital of Yopougon University Medical Center, Abidjan, Côte d'Ivoire
| | - F Despas
- Hematology Department of Toulouse University Medical Center, Toulouse, France
| | - G Laurent
- Hematology Department of Toulouse University Medical Center, Toulouse, France
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19
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Afungchwi GM, Hesseling P, van Elsland SL, Kouya F, Kruger M. Destitution, treatment adherence and survival of children with Burkitt lymphoma in a twinning programme in Northwest Cameroon. Pediatr Blood Cancer 2019; 66:e27946. [PMID: 31436364 DOI: 10.1002/pbc.27946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Burkitt lymphoma (BL) is a curable childhood cancer. Treatment adherence is crucial for a good outcome, but is potentially problematic in low- and middle-income countries owing to parental financial constraints. AIMS To investigate the association of destitution with treatment adherence and its effect on the survival of patients with BL. METHODS Patients received free medical treatment from a twinning programme at two Cameroon Baptist hospitals. A destitution assessment questionnaire, based on socioeconomic status, was completed at diagnosis. Medical records were reviewed for treatment adherence and survival. Chi-squared and Fisher's exact tests were used to compare groups. Kaplan-Meier plots were used to calculate overall survival, and log-rank chi-squared tests when comparing survival rates between patient subgroups. Significance was measured at P < .05. RESULTS The 225 children with BL had a mean age of 8.2 years (median 8.0) and the overall survival was 52%. The mean family destitution score was 56% on a linear scale. Few (8%) patients delayed treatment appointments. A quarter (25%) experienced more than a 1-week follow-up delay and 9.8% absconded within 1 year. The destitution score was not significantly associated with delay of treatment, but with delay in follow-up (P < .001). Guardian relationship (single mother) and patient's age were significantly associated with overall survival (P = .025). CONCLUSIONS Though linked to poor follow-up, destitution was not significantly associated with absconding patients, poor outcome or poor adherence to treatment, probably due to comprehensive financial support from the international twinning programme. However, additional support for single mothers should be considered.
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Affiliation(s)
- Glenn M Afungchwi
- Department of Paediatrics, Mbingo Baptist Hospital, Banso, Cameroon.,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Francine Kouya
- Department of Paediatrics, Mbingo Baptist Hospital, Banso, Cameroon
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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20
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Sinha S, Brattström G, Palat G, Rapelli V, Segerlantz M, Brun E, Wiebe T. Treatment Adherence and Abandonment in Acute Myeloid Leukemia in Pediatric Patients at a Low-Resource Cancer Center in India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aim: One of the causes for lower cure rates in acute childhood leukemia in low- and middle- income countries (LMIC) compared to high-income countries is abandonment from treatment. The International Society of Pediatric Oncology (SIOP) defines abandonment as failure to begin treatment or an absence of 4 weeks during treatment. The aim of this study was to evaluate the extent of abandonment among patients diagnosed with acute myeloid leukemia (AML) at the pediatric ward at a low-resource cancer center in India. Methods: Medical records of all patients, aged 0–15 years, diagnosed with AML between January 1, 2014, and March 31, 2015, at the hospital were reviewed. Age, sex, date of diagnosis, and survival during the short follow-up time after completed treatment and information regarding abandonment were collected. SIOP definition of abandonment was used. Eight patients were diagnosed with AML at the hospital whereof 65 met the inclusion criteria of this study. Results: Of the included 65 patients, 6 died before treatment could be initiated and 3 were referred to palliative care upfront. Thus, 56 patients were offered curatively intended treatment. Of these patients, six refused treatment at this stage and another five abandoned during therapy. Altogether, 11 children abandoned treatment. Conclusion: In this study, the abandonment rate from treatment of childhood AML was 20%, which is in concordance from other studies conducted in India and other LMIC, stating that abandonment is a problem and hindrance when treating with a curative intent.
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Affiliation(s)
- Sudha Sinha
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | | | - Gayatri Palat
- Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
- Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Vineela Rapelli
- Palliative Care Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane
| | - Eva Brun
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University
- Department of Radiotherapy and Radiophysics, Skane University Hospital
| | - Thomas Wiebe
- Department of Clinical Sciences, Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
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21
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Cowgill KD, Ntambue AM. Hospital detention of mothers and their infants at a large provincial hospital: a mixed-methods descriptive case study, Lubumbashi, Democratic Republic of the Congo. Reprod Health 2019; 16:111. [PMID: 31331396 PMCID: PMC6647063 DOI: 10.1186/s12978-019-0777-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background The practice of detaining people who are unable to pay for health care services they have received is widespread in many parts of the world. We aimed to determine the proportion of women and their infants detained for inability to pay for services received at a provincial hospital in the Democratic Republic of the Congo during a 6-week period in 2016. A secondary objective was to determine clinical and administrative staff attitudes and practices about payment for services and detention. Methods This mixed-methods descriptive case study included a cross-sectional survey and interviews with key informants. Results Over half (52%) of the 85 women who were in the maternity ward at Sendwe Hospital and eligible for discharge between August 5 and September 15, 2016 were detained for 1 to 30 days for outstanding bills of United States dollars (USD) 21 to USD 515. Women who were detained were younger, poorer, and had more obstetric complications and caesarean sections than other women. In addition, over one quarter of the infants born to these women had died during delivery or in the first three days of life. Key informant interviews normalized detention as an unfortunate but inevitable consequence of patient poverty and health system resource constraints. Conclusions Detention of women and their infants is common at this hospital in the DRC. This represents a violation of human rights and a systemic failure to ensure that all people have access to essential health services and that they not suffer financial hardship due to the price of those services.
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Affiliation(s)
- Karen D Cowgill
- School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, USA. .,Department of Global Health, University of Washington, Seattle, USA.
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22
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Olbara G, Martijn HA, Njuguna F, Langat S, Martin S, Skiles J, Vik T, Kaspers GJL, Mostert S. Influence of health insurance status on childhood cancer treatment outcomes in Kenya. Support Care Cancer 2019; 28:917-924. [DOI: 10.1007/s00520-019-04859-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science 2019; 363:1182-1186. [DOI: 10.1126/science.aaw4892] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through multidisciplinary care and research, with treatment regimens using mostly generic medicines and optimized risk stratification. Children’s outcomes in LMICs can be improved through global collaborative partnerships that help local leaders adapt effective treatments to local resources and clinical needs, as well as address common problems such as delayed diagnosis and treatment abandonment. Together, these approaches may bring within reach the global survival target recently set by the World Health Organization: 60% survival for all children with cancer by 2030.
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Chantada G, Lam CG, Howard SC. Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment. Br J Haematol 2019; 185:1125-1135. [DOI: 10.1111/bjh.15785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Catherine G. Lam
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis TNUSA
| | - Scott C. Howard
- University of Tennessee Health Science Center Memphis TN USA
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Olbara G, Parigger J, Njuguna F, Skiles J, Sitaresmi MN, Gordijn S, van de Ven P, Kaspers G, Mostert S. Health-care providers' perspectives on traditional and complementary alternative medicine of childhood cancer in Kenya. Pediatr Blood Cancer 2018; 65:e27309. [PMID: 30051647 DOI: 10.1002/pbc.27309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Traditional and complementary alternative medicine (TCAM) use is rising globally. In many African countries, TCAM has been a way of life as the first and last resort remedy for many ailments, including cancer. Health-care providers (HCP) should address this need properly. This study explores HCP perspectives on TCAM in Kenya. METHODS This cross-sectional study used questionnaires. HCP involved in the care of children with cancer at a Kenyan academic hospital were interviewed. RESULTS In total, 155 HCP (response rate 79%) participated. Only 18% of HCP were positive about TCAM use. However, most HCP (85%) use TCAM themselves. More doctors (90%) than other HCP (56%) think that chemotherapy can cure cancer (P < 0.001).Thirty-three percent of HCP believe a combination of TCAM and chemotherapy is the best way to cure cancer, while 56% think that usefulness of TCAM is underestimated in conventional medicine. Self-prayer is regarded as most effective (58%) and safe (76%). Most harmful is witchcraft (80%). Most HCP (71%) think their knowledge about safety and efficacy of TCAM is inadequate. HCP think that their cancer patients use TCAM (97%) and that it is important that parents inform them about this (97%). However, only 5% of HCP always openly discuss TCAM with parents. CONCLUSIONS HCP need to improve their knowledge of TCAM and facilitate open communication about TCAM with families so parents feel safe to discuss their interest in it.
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Affiliation(s)
- Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Josta Parigger
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor program, VU University Medical Center, Amsterdam, the Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis
| | | | - Suzanne Gordijn
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor program, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Gertjan Kaspers
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor program, VU University Medical Center, Amsterdam, the Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor program, VU University Medical Center, Amsterdam, the Netherlands
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Mostert S, Njuguna F, van der Burgt RHM, Musimbi J, Langat S, Skiles J, Seijffert A, Sitaresmi MN, Vik TA, van de Ven PM, Kaspers GJL. Health-care providers' perspectives on health-insurance access, waiving procedures, and hospital detention practices in Kenya. Pediatr Blood Cancer 2018; 65:e27221. [PMID: 29741267 DOI: 10.1002/pbc.27221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. PROCEDURE A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care. RESULTS The perspectives of respondents were as follows: all children with cancer should have health insurance according to 96% of HCP. After parents apply for health insurance, it takes too long before treatment costs are covered (67% agree). Patients with childhood cancer without health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving procedures take too long (75%). Parents are scared by waiving procedures and may decide never to return to the hospital again (68%). Poor families delay visiting the hospital because they fear hospital detention and first seek alternative treatment (92%). When poor families finally come to the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at the hospital if parents cannot pay their medical bills is not approved by 84% of HCP. CONCLUSIONS HCP acknowledge that access to health insurance needs improvement and that waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospital detention practices. These factors warrant urgent attention and adjustment.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Renske H M van der Burgt
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Joyce Musimbi
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anneloes Seijffert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mei N Sitaresmi
- Department of Pediatrics, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Terry A Vik
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Owenga JA, Nyambedha EO. Perception of Cervical Cancer Patients on their Financial Challenges in Western Kenya. BMC Health Serv Res 2018; 18:261. [PMID: 29631577 PMCID: PMC5891984 DOI: 10.1186/s12913-018-3073-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of cervical cancer cases is reported to increase among women of reproductive age in the recent past with patients facing challenges with care and management of the illness. However, little is known about the financial challenges these patients undergo in contexts such as western Kenya. This study assessed financial challenges and sources of financial assistance for cervical cancer patients in western Kenya. METHODS A cross-sectional study involving 334 cervical cancer patients was conducted in Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu from September 2014 to February 2015. Structured questionnaire, in-depth interview guide and key informant interview guide were used to collect data. Quantitative data was analyzed using Statistical Package for Social Scientists (SPSS) Version 20 at a statistical significance of P ≤ 0.05, descriptive statistics and crosstabulations were performed. For qualitative data, the responses were transcribed verbatim and the content was then analyzed by searching for emerging themes on the financial challenges faced by cervical cancer patients. Qualitative data was presented in textual form with verbatim reports for illustrations. RESULTS The key financial challenges from the study were costs of medication 291 (87%), cost of travel 281 (84%) and cost of diagnostic tests 250 (75%). Other costs incurred by the patients were cost of cloths and wigs 91 (27%), and cost of home and child care 80 (24%). Most 304 (91%) of the cervical cancer patients admitted and referred to JOOTRH did not have insurance cover and only 30 (9%) had National Hospital Insurance Fund cover which catered for only bed component of inpatient costs. Results showed that no patient received any assistance from well-wishers. Only a few received assistance from charity organizations 43 (13%), friends 91 (27%) and colleagues 31 (9%). Some patients received some assistance from relatives 32 (10%) and church 32 (10%). CONCLUSION Cervical cancer patients experience several financial challenges yet only few of them had insurance cover which catered for only bed component of inpatient costs. There is a need for the Kenyan health care system to develop mechanisms for provision of financial support for cervical cancer patients.
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Affiliation(s)
- Jane A Owenga
- Jaramogi Oginga Odinga University of Science and Technology, P.O Box.210-40601, Bondo, Kenya.
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Siddiqui DEF, Ashraf MS, Iftikhar S, Belgaumi AF. Predictors of treatment abandonment for patients with pediatric cancer at Indus Children Cancer Hospital, Karachi, Pakistan. Pediatr Blood Cancer 2018; 65. [PMID: 28960700 DOI: 10.1002/pbc.26818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/22/2017] [Accepted: 08/22/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Abandonment of treatment is one of the toughest challenges to deal with in pediatric oncology. It leads to unnecessary mortality and morbidity in patients from low- and middle-income countries. PROCEDURE The objective of our retrospective study was to determine the prevalence and predictors for abandonment among children with cancer at our hospital in Karachi, Pakistan. We analyzed data on patients younger than 18 years, diagnosed with any malignancy between November 2014 and May 2016. RESULTS From a total of 821 patients, one hundred and eighty-two (22.2%) patients abandoned treatment at various stages, 92 (11.2%) patients did not initiate treatment at all, and the remaining 90 (11.0%) left during treatment. The gender ratio at registration was skewed toward males but not statistically significant for abandonment. Of 295 registered females, 74 (25.1%) abandoned treatment compared to 108 (20.5%) abandonments among 526 males. In multivariable regression analysis, the type of malignancy, guardian's profession, and travelling from outside the city of Karachi (odds ratio [OR]: 1.48; 95% confidence interval [CI] 1.02-2.15; P = 0.039) correlated with increased abandonment. Treatment abandonment was higher among patients with brain tumors (45.7%) and solid tumors (30.8%) and among those whose guardians were associated with a rural profession (24.7%). Monthly income, age, and number of siblings had no impact on the decision to abandon treatment. CONCLUSION Despite the provision of free treatment, the prevalence of abandonment was high. More qualitative data need to be collected to identify and target groups of individuals who may be likely to abandon treatment, thus improving outcome of patients.
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Affiliation(s)
- Durr-E-Fatima Siddiqui
- Department of Pediatric Oncology, Indus Children Cancer Hospital, The Indus Hospital, Karachi, Pakistan
| | - Muhammad Shamvil Ashraf
- Department of Pediatric Oncology, Indus Children Cancer Hospital, The Indus Hospital, Karachi, Pakistan
| | - Sundus Iftikhar
- Statistics & Training Unit, Indus Hospital Research Centre, The Indus Hospital, Karachi, Pakistan
| | - Asim F Belgaumi
- Division of Hematology/Oncology, Department of Pediatric Medicine, Sidra Medical and Research Center, Doha, Qatar.,Weill-Cornell Medical College-Qatar, Doha, Qatar
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Handayani K, Sitaresmi MN, Supriyadi E, Widjajanto PH, Susilawati D, Njuguna F, van de Ven PM, Kaspers GJL, Mostert S. Delays in diagnosis and treatment of childhood cancer in Indonesia. Pediatr Blood Cancer 2016; 63:2189-2196. [PMID: 27510358 DOI: 10.1002/pbc.26174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/22/2016] [Accepted: 07/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emphasizing timely diagnosis and treatment of cancer are important themes in pediatric cancer management, as delays adversely impact survival. This study explores various delay types among children with cancer and determines factors that influence delays. METHODS This cross-sectional study was conducted at an Indonesian academic hospital. Parents of newly diagnosed patients were interviewed between October 2013 and September 2014 using semistructured questionnaires. Patient, physician, diagnosis, treatment, healthcare system (HCS), and total delay were analyzed. RESULTS Parents of 145 children (response rate 89%) with cancer were interviewed. Median total delay was 70 days (range 5-4,055). Patient delay (median 5 days, range 0-189) was significantly shorter than HCS delay (median 49 days, range 4-4,025, P < 0.001). Diagnosis delay (median 58 days, range 3-4,015) was significantly longer than treatment delay (median 3 days, range 1-89, P < 0.001). Older age at diagnosis significantly lengthened patient delay (P = 0.044). Using alternative treatment was associated with significantly longer patient and total delay (P = 0.025, 0.024, respectively). Cancer type significantly influenced physician, diagnosis, treatment, HCS, and total delay (P = 0.001, P = 0.004, P < 0.001, P < 0.001, P < 0.001, respectively). Neurological tumors had the longest delays, whereas hematological tumors had the shortest. Sex, parents' education or income level, disease stage at diagnosis, health insurance status, distance from hospital, and first attended health-facility type did not significantly impact the length of any delay type. CONCLUSIONS Healthcare providers need training to improve recognition of cancer symptoms and speed up subsequent diagnostic processes. Using alternative treatment increased patient and total delays. Community campaigns to encourage families to seek conventional cancer treatments are recommended.
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Affiliation(s)
- K Handayani
- Department of Pediatrics, Nyi Ageng Serang District Hospital, Yogyakarta, Indonesia.
| | - M N Sitaresmi
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E Supriyadi
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P H Widjajanto
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - D Susilawati
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - F Njuguna
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - P M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - G J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey. PLoS One 2016; 11:e0163090. [PMID: 27736871 PMCID: PMC5063311 DOI: 10.1371/journal.pone.0163090] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject. METHODS Physicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately. RESULTS 581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families' low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others. CONCLUSION TxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.
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Buckle G, Maranda L, Skiles J, Ong'echa JM, Foley J, Epstein M, Vik TA, Schroeder A, Lemberger J, Rosmarin A, Remick SC, Bailey JA, Vulule J, Otieno JA, Moormann AM. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study. Int J Cancer 2016; 139:1231-40. [PMID: 27136063 PMCID: PMC5489240 DOI: 10.1002/ijc.30170] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/19/2016] [Indexed: 12/23/2022]
Abstract
Discovering how to improve survival and establishing clinical reference points for children diagnosed with endemic Burkitt lymphoma (eBL) in resource-constrained settings has recaptured international attention. Using multivariate analyses, we evaluated 428 children with eBL in Kenya for age, gender, tumor stage, nutritional status, hemoglobin, lactate dehydrogenase (LDH), Epstein-Barr virus (EBV) and Plasmodium falciparum prior to induction of chemotherapy (cyclophosphamide, vincristine, methotrexate and doxorubicin) to identify predictive and prognostic biomarkers of survival. During this 10 year prospective study period, 22% died in-hospital and 78% completed six-courses of chemotherapy. Of those, 16% relapsed or died later; 31% achieved event-free-survival; and 31% were lost to follow-up; the overall one-year survival was 45%. After adjusting for covariates, low hemoglobin (<8 g/dL) and high LDH (>400 mU/ml) were associated with increased risk of death (adjusted Hazard Ratio (aHR) = 1.57 [0.97-2.41]) and aHR = 1.84, [0.91-3.69], respectively). Anemic children with malaria were 3.55 times more likely to die [1.10-11.44] compared to patients without anemia or malarial infection. EBV load did not differ by tumor stage nor was it associated with survival. System-level factors can also contribute to poor outcomes. Children were more likely to die when inadvertently overdosed by more than 115% of the correct dose of cyclophosphamide (a HR = 1.43 [0.84-2.43]) or doxorubicin (a HR = 1.25, [0.66-2.35]), compared with those receiving accurate doses of the respective agent in this setting. This study codifies risk factors associated with poor outcomes for eBL patients in Africa and provides a benchmark by which to assess improvements in survival for new chemotherapeutic approaches.
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Affiliation(s)
- Geoffrey Buckle
- Molecular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655
| | - Louise Maranda
- Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, ASC6.1063, Worcester, MA 01655
| | - Jodi Skiles
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, RI 2629, Indianapolis, IN 46202
| | - John Michael Ong'echa
- Center for Global, Health Research Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Joslyn Foley
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation St. Biotech 2, Suite 318, Worcester, MA 01605
| | - Mara Epstein
- Quantitative Health Sciences, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA 01605
| | - Terry A. Vik
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | | | | | - Alan Rosmarin
- Medicine, Hematology/Oncology, University of Massachusetts Medical School, 55 Lake Avenue North, H8-533, Worcester, MA 01655
| | - Scot C. Remick
- Physician Leader, Oncology and Senior Scientist, Maine Medical Center and Maine Medical Center Research Institute, Portland, ME 04074
| | - Jeffrey A. Bailey
- Medicine, Bioinformatics, University of Massachusetts Medical School, 55 Lake Avenue North, ASC4.1077, Worcester, MA 01655
| | - John Vulule
- Center for Global Health Research, Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Juliana A. Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya Ministry of Health, P.O. Box 849-40100, Kisumu, Kenya
| | - Ann M. Moormann
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Biotech 2, Suite 318, Worcester MA, 01605 USA
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Travado L, Breitbart W, Grassi L, Fujisawa D, Patenaude A, Baider L, Connor S, Fingeret M. 2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue-challenges and opportunities. Psychooncology 2016; 26:563-569. [PMID: 27530206 DOI: 10.1002/pon.4209] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 11/08/2022]
Abstract
The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the "Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right" was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward.
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Affiliation(s)
- Luzia Travado
- Psycho-oncology Service, Clinical Center of the Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luigi Grassi
- Unit of Clinical Psychiatry, Department of Biomedical and Speciality Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Daisuke Fujisawa
- Department of Neuropsychiatry and Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
| | - Andrea Patenaude
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lea Baider
- Institute of Clinical Oncology, Assuta Medical Center, Tel Aviv, Israel
| | | | - Michelle Fingeret
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Ospina-Romero M, Portilla CA, Bravo LE, Ramirez O. Caregivers' Self-Reported Absence of Social Support Networks is Related to Treatment Abandonment in Children With Cancer. Pediatr Blood Cancer 2016; 63:825-31. [PMID: 26871640 DOI: 10.1002/pbc.25919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/21/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment abandonment (TxA) is a primary cause of therapy failure in children with cancer in low-/middle-income countries. We explored the absence of social support network (SSN), among other predictive factors, and TxA in children with cancer in Cali, Colombia. PROCEDURE In this prospective cohort study, we included children diagnosed with cancer at a public university hospital. A social worker and a psychologist administered semistructured questionnaires to patients' caregivers. We extracted information from the questionnaires about social, economic, and psychological conditions of the patients' families. Outcomes were death, relapse, and TxA. Failure either to start or to continue the planned course of curative treatment for 4 weeks or more was defined as TxA. We identified events with Cali's childhood cancer outcomes surveillance system (VIGICANCER). We adjusted the hazard ratios (HRs) for potential confounders using multivariate Cox regression analyses. RESULTS Among 188 patients diagnosed from January 2011 to June 2013, 99 interviews were conducted. Median age was 5 years old (range: 0.3, 14.9), 53% were male, 17% were of Colombian-Indian ethnicity, and 68% lived in rural areas. The 2-year cumulative incidence of TxA was 21% (95% confidence interval [CI]: 13, 35) and the annual proportion was 14%. The adjusted HR for the absence of SSN was 4.9 (95% CI: 1.6, 15.3). CONCLUSIONS We found a strong association between the absence of SSN and TxA that was independent of other covariates, including surrogate measures of wealth. Our findings highlight the imperative understanding of social ties and support surrounding children's families for planning strategies to prevent TxA.
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Affiliation(s)
| | - Carlos Andrés Portilla
- School of Medicine, Universidad del Valle, Cali, Colombia.,Valley Public University Hospital, Cali, Colombia.,POHEMA Foundation, Cali, Colombia
| | - Luis Eduardo Bravo
- School of Medicine, Universidad del Valle, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
| | - Oscar Ramirez
- POHEMA Foundation, Cali, Colombia.,Imbanaco Medical Center, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
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Njuguna F, Martijn H, Langat S, Musimbi J, Muliro H, Skiles J, Vik T, Sitaresmi MN, van de Ven PM, Kaspers GJL, Mostert S. Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya. Pediatr Hematol Oncol 2016; 33:186-99. [PMID: 27184775 DOI: 10.3109/08880018.2016.1169566] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media.
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Affiliation(s)
- F Njuguna
- a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya
| | - H Martijn
- b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands
| | - S Langat
- a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya
| | - J Musimbi
- a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya
| | - H Muliro
- a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya
| | - J Skiles
- c Division of Hemato-Oncology , Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - T Vik
- c Division of Hemato-Oncology , Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - M N Sitaresmi
- d Department of Pediatrics , Dr. Sardjito Hospital , Yogyakarta , Indonesia
| | - P M van de Ven
- e Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands
| | - G J L Kaspers
- b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands
| | - S Mostert
- b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands
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Wang C, Yuan XJ, Jiang MW, Wang LF. Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma. J Neurosurg Pediatr 2016; 17:49-56. [PMID: 26451721 DOI: 10.3171/2015.5.peds1573] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients' median age at diagnosis was 51.96 months (range 3.96-168.24 months). The median duration of follow-up was 32 months (range 3-70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p < 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p < 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases). CONCLUSIONS There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents' misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.
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Affiliation(s)
- Chen Wang
- Departments of 1 Pediatric Hematology/Oncology
| | | | | | - Li-Feng Wang
- Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Binagwaho A, Wagner CM, Farmer PE. A Vision for Global Cancer Medicine: Pursuing the Equity of Chance. J Clin Oncol 2015; 34:3-5. [PMID: 26578610 DOI: 10.1200/jco.2015.62.4395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
At the turn of the century, some claimed that HIV/AIDS was a disease that could not be managed in low-income settings. It was argued that "poor people would not comply with treatment," and that treatment was too expensive and too complicated to deliver. But over the past two decades, data on outcomes have thoroughly disproved this myth. Similar arguments have more recently been made about cancer treatment: chemotherapy was said to be too toxic and too costly and that it required administration expertise beyond that available in low-income settings. We argue that these claims are similarly rooted in ideology rather than evidence. Fortunately, such claims are starting to be refuted by a diverse set of global cancer partnerships around the world that are documenting progress and positive results. In this review article, we provide examples of programs that can give us reason to hope that the treatment playing field is being leveled such that birthplace does not determine survival prognosis. We believe that through strong collaborative efforts and solidarity, the equity of chance can be achieved for patients with cancer worldwide.
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Affiliation(s)
- Agnes Binagwaho
- Agnes Binagwaho, Ministry of Health of Rwanda, Kigali, Rwanda, Harvard Medical School, Boston, MA, and Geisel School of Medicine at Dartmouth College, Hanover, NH; Claire M. Wagner, Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA, and Union for International Cancer Control, Geneva, Switzerland; and Paul E. Farmer, Harvard Medical School, Partners In Health, and Brigham and Women's Hospital, Boston, MA.
| | - Claire M Wagner
- Agnes Binagwaho, Ministry of Health of Rwanda, Kigali, Rwanda, Harvard Medical School, Boston, MA, and Geisel School of Medicine at Dartmouth College, Hanover, NH; Claire M. Wagner, Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA, and Union for International Cancer Control, Geneva, Switzerland; and Paul E. Farmer, Harvard Medical School, Partners In Health, and Brigham and Women's Hospital, Boston, MA
| | - Paul E Farmer
- Agnes Binagwaho, Ministry of Health of Rwanda, Kigali, Rwanda, Harvard Medical School, Boston, MA, and Geisel School of Medicine at Dartmouth College, Hanover, NH; Claire M. Wagner, Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA, and Union for International Cancer Control, Geneva, Switzerland; and Paul E. Farmer, Harvard Medical School, Partners In Health, and Brigham and Women's Hospital, Boston, MA
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Mostert S, Njuguna F, Olbara G, Sindano S, Sitaresmi MN, Supriyadi E, Kaspers G. Corruption in health-care systems and its effect on cancer care in Africa. Lancet Oncol 2015; 16:e394-404. [PMID: 26248847 DOI: 10.1016/s1470-2045(15)00163-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 01/09/2023]
Abstract
At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Solomon Sindano
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Mei Neni Sitaresmi
- Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Pediatric Hematology-Oncology Division, Department of Pediatrics, Gadjah Mada University, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, Netherlands
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Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, Hanna TP, Knaul FM, Lievens Y, Lui TYM, Milosevic M, O'Sullivan B, Rodin DL, Rosenblatt E, Van Dyk J, Yap ML, Zubizarreta E, Gospodarowicz M. Expanding global access to radiotherapy. Lancet Oncol 2015; 16:1153-86. [PMID: 26419354 DOI: 10.1016/s1470-2045(15)00222-3] [Citation(s) in RCA: 626] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022]
Abstract
Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and $284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015-35 (-$14·9 billion in low-income countries; -$18·7 billion in lower-middle-income countries, and $50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (-$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and $95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.
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Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA.
| | - David A Jaffray
- Princess Margaret Cancer Centre, Toronto, ON, Canada; TECHNA Institute, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael B Barton
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Michael Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bhadrasain Vikram
- National Cancer Institute, US National Institutes of Health, Bethesda, MD, USA
| | - Timothy P Hanna
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Yolande Lievens
- Ghent University Hospital, Ghent, Belgium; Ghent University, Ghent, Belgium
| | - Tracey Y M Lui
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | | | - Brian O'Sullivan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Danielle L Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Jacob Van Dyk
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Mei Ling Yap
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | | | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Mostert S, Lam CG, Njuguna F, Patenaude AF, Kulkarni K, Salaverria C. Hospital detention practices: statement of a global taskforce. Lancet 2015; 386:649. [PMID: 26334151 PMCID: PMC5506487 DOI: 10.1016/s0140-6736(15)61495-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Carmen Salaverria
- National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
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40
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Ceppi F, Antillon F, Pacheco C, Sullivan CE, Lam CG, Howard SC, Conter V. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries. Expert Rev Hematol 2015; 8:613-26. [DOI: 10.1586/17474086.2015.1049594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kulkarni KP. In the realms of future: new frontiers of 'techno-oncology' as a platform for global improvement in the outcomes of childhood cancer. Expert Rev Hematol 2014; 8:1-4. [PMID: 25537882 DOI: 10.1586/17474086.2015.995623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The survival outcome of childhood cancers in developing nations has failed to keep pace with that of developed nations. Technological advances offer a unique and radical opportunity to develop programs and strategies to improve outcomes of childhood cancer globally. The novel field of 'techno-oncology' has a broad scope and the potential to phenomenally impact, revamp and model the care of pediatric cancer patients in the developing world. Many frontiers and opportunities in the area remain to be explored as well as many challenges to be surmounted.
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Affiliation(s)
- Ketan P Kulkarni
- Department of Pediatrics, Division of Hematology/Oncology, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8, Canada
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Njuguna F, Mostert S, Seijffert A, Musimbi J, Langat S, van der Burgt RHM, Skiles J, Sitaresmi MN, van de Ven PM, Kaspers GJL. Parental experiences of childhood cancer treatment in Kenya. Support Care Cancer 2014; 23:1251-9. [PMID: 25318695 DOI: 10.1007/s00520-014-2475-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 10/06/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE Our study explores socioeconomic, treatment-related, and psychological experiences of parents during cancer treatment of their children at an academic hospital in Kenya. METHODS This cross-sectional study used semi-structured questionnaires. Parents whose children came for cancer treatment consecutively between November 2012 and April 2013 were interviewed. RESULTS Between 2012 and 2013, 115 oncology patients attended the hospital and 75 families (response rate 65 %) were interviewed. Cancer treatment resulted in financial difficulties (89 %). More information about cancer and treatment was required (88 %). More contact with doctors was needed (83 %). At diagnosis, cancer was perceived as curable (63 %). However, parents were told by health-care providers that most children with cancer die (49 %). Parents had difficulties with understanding doctors' vocabulary (48 %). Common reasons to miss hospital appointments were travel costs (52 %) and hospital costs (28 %). Parents (95 %) used complementary alternative treatment (CAM) for their children. Health-care providers told parents not to use CAM (49 %). Parents had not discussed their CAM use with doctors (71 %). Community members isolated families because their child had cancer (25 %), believed that child was bewitched (57 %), advised to use CAM (61 %), and stopped conventional treatment (45 %). Some families (15 %) never disclosed the child's illness to community members. Parents shared experiences with other parents at the ward (97 %) and would otherwise not understand the disease and its treatment (87 %). CONCLUSIONS Parents suffer financial hardships and are dissatisfied with doctors' communication regarding their children's condition. CAM is very commonly used. Doctors need to improve their communication skills and discuss CAM more openly. Cancer programs should include more support for parents: financial assistance, a facility where parents and children can stay during the course of therapy, and parent support groups.
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Affiliation(s)
- F Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya,
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