Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya.

Autor: Langat S; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. sandralangat@gmail.com.; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands. sandralangat@gmail.com., Njuguna F; Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya., Olbara G; Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya., Martijn H; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Sieben C; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Haverkort M; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Njenga D; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya., Vik TA; 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., Kaspers G; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands., Mostert S; Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2023 Jul 15; Vol. 31 (8), pp. 467. Date of Electronic Publication: 2023 Jul 15.
DOI: 10.1007/s00520-023-07913-1
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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