Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey

Autor: Raul C. Ribeiro, Geetinder Kaur, Catherine G. Lam, Paola Friedrich, Elena Itriago, Ramandeep Singh Arora
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Culture
Alternative medicine
Vulnerability
Cancer Treatment
lcsh:Medicine
Surveys
Pediatrics
Families
0302 clinical medicine
Neoplasms
Surveys and Questionnaires
Medicine and Health Sciences
lcsh:Science
Child
Children
Multidisciplinary
Social work
Sarcomas
Prognosis
3. Good health
Oncology
Research Design
030220 oncology & carcinogenesis
Research Article
medicine.medical_specialty
MEDLINE
Developing country
Research and Analysis Methods
03 medical and health sciences
Diagnostic Medicine
Comparative research
medicine
Cancer Detection and Diagnosis
Humans
Socioeconomic status
Survey Research
business.industry
lcsh:R
Cancers and Neoplasms
Pediatric cancer
Surgery
Socioeconomic Factors
Pediatric Oncology
Age Groups
Family medicine
People and Places
lcsh:Q
Population Groupings
business
030215 immunology
Zdroj: PLoS ONE
PLoS ONE, Vol 11, Iss 10, p e0163090 (2016)
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
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