Influence of health insurance status on childhood cancer treatment outcomes in Kenya.

Autor: Olbara G; Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya. olbara112@yahoo.com., Martijn HA; Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands., Njuguna F; Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya., Langat S; Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya., Martin S; Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, USA., Skiles J; Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, USA., Vik T; Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, USA., Kaspers GJL; Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands., Mostert S; Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2020 Feb; Vol. 28 (2), pp. 917-924. Date of Electronic Publication: 2019 Jun 07.
DOI: 10.1007/s00520-019-04859-1
Abstrakt: Background: Survival of childhood cancer in high-income countries is approximately 80%, whereas in low-income countries, it is less than 10%. Limited access to health insurance in low-income settings may contribute to poor survival rates. This study evaluates the influence of health insurance status on childhood cancer treatment in a Kenyan academic hospital.
Methods: This was a retrospective study. All children diagnosed with a malignancy from 2010 until 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were abstracted from patient charts.
Results: Of 280 patients, 34% abandoned treatment, 19% died, and 18% had progressive or relapsed disease resulting in 29% event-free survival. The majority of patients (65%) did not have health insurance at diagnosis. Treatment results differed significantly between patients with different health insurance status at diagnosis; 37% of uninsured versus 28% of insured patients abandoned treatment, and 24% of uninsured versus 37% of insured patients had event-free survival. The event-free survival estimate was significantly higher for patients with health insurance at diagnosis compared with those without (P = 0.004). Of patients without health insurance at diagnosis, 77% enrolled during treatment. Among those patients who later enrolled in health insurance, frequency of progressive or relapsed disease and deaths was significantly lower (P = 0.013, P < 0.001, respectively), while the event-free survival estimate was significantly higher (P < 0.001) compared with those who never enrolled.
Conclusion: Childhood cancer event-free survival was 29% at a Kenyan hospital. Children without health insurance had significant lower chance of event-free survival. Childhood cancer treatment outcomes could be ameliorated by strategies that prevent treatment abandonment and improve access to health insurance.
Databáze: MEDLINE
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