Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi
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Lymphoma is the commonest pediatric cancer in sub-Saharan Africa (SSA). Frequent treatment abandonment contributes to suboptimal outcomes. We examined risk factors and reasons for treatment abandonment for this population in Malawi.
We conducted a mixed methods study among children < 18 years old with newly diagnosed lymphoma, prospectively enrolled during 2013–2016. All children received standardized diagnosis and treatment, and were followed for up to 2 years. Treatment abandonment was defined as failure to attend prescribed chemotherapy within 4 weeks, or post-treatment visit within 3 months. Child, guardian, and household characteristics associated with treatment abandonment were assessed. Semi-structured interviews were conducted with primary caregivers of children experiencing treatment abandonment.
Of 121 children with newly diagnosed lymphoma, 72 (60%) had complete information regarding child, guardian, and household characteristics. Of these, 56 (78%) had Burkitt’s and 16 (22%) Hodgkin’s lymphoma. Forty-nine (68%) were male, median age was 10.6 years (interquartile range [IQR] 7.9–13.0), and 26 (36%) experienced treatment abandonment. Lack of guardian education and travel time ≥ 4 h to clinic were independently associated with treatment abandonment, with adjusted hazard ratio (aHR) 3.8 [95% confidence interval (CI) 1.5–8.9, p = 0.005] and aHR 2.9 (95% CI 1.2–6.9, p = 0.019), respectively. Commonest reasons for treatment abandonment endorsed by 15 guardians were community influence, suboptimal clinic environment, logistical challenges, transport costs, treatment toxicities, loss of hope, alternative healers, and beliefs about cure.
These findings highlight families at risk for treatment abandonment, underlying reasons, and opportunities to improve retention in care for pediatric cancer patients in SSA.
KeywordsLymphoma treatment abandonment sub-Saharan Africa
The authors would like to thank the patients and their families for agreeing to participate in the study. We are also grateful to the leadership of Kamuzu Central Hospital, Malawi Ministry of Health, UNC Project-Malawi, Lineberger Comprehensive Cancer Center, and Baylor College of Medicine Children’s Foundation Malawi for support of this study.
This work is supported by grants from the National Institutes of Health (K01TW009488, U54CA190152, and P30CA016086-40S4).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The authors have full control of all primary data and agree to allow the journal to review these data if requested.
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