title: A report about treatment refusal and abandonment in children with acute lymphoblastic leukemia in China, 1997-2007.
abstract: BACKGROUND
  To analyze the causes and consequence of treatment refusal and abandonment in childhood acute lymphoblastic leukemia (ALL) treated in Wuhan Union Hospital of China.
  
  
  METHODS
  We collected recorded data and interviewed families of the children with ALL diagnosed between January 1997 and August 2007, who refused or abandoned treatment.
  
  
  RESULTS
  323 patients were diagnosed with ALL. 173 patients (173/323, 53.6%) refused therapy and 35 (35/323, 10.8%) cases abandoned treatment. 191 (191/208, 91.8%) of these children were telephone/mail-visited. Different people had different reasons for refusal or abandonment. Financial difficulty and belief of ALL incurability were the main reasons for abandonment. Transportation difficulties and fear of severe side effects were also important reasons. Of the 173 patients who refused treatment, 13 patients lost follow-up. 160 parents were interviewed and 1 (6.3%) child was still alive at the date of last follow-up. Of the 35 patients who abandoned treatment, 4 patients lost follow-up. 31 parents were interviewed and 2 (6.5%) children were still alive at the date of last follow-up.
  
  
  CONCLUSIONS
  Medical insurance and a systemic health education are extremely required for childhood ALL in low middle income countries.
authors.affiliation: Department of Pediatrics, The Affiliated Shenzhen Third Hospital, Guangdong Medical College, Shenzhen, China. 123rong@sohu.com
authors.forename: Yan-rong
authors.initials: YR
authors.lastname: Wang
authors.forename: Run-ming
authors.initials: RM
authors.lastname: Jin
authors.forename: Jia-wei
authors.initials: JW
authors.lastname: Xu
authors.forename: Zhi-quan
authors.initials: ZQ
authors.lastname: Zhang
mesh_terms: D017668:Age of Onset; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data / Q000639:trends; D002670:Child, Abandoned / Q000706:statistics & numerical data; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010287:Parent-Child Relations; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012042:Registries / Q000706:statistics & numerical data; D016019:Survival Analysis; D016312:Treatment Refusal / Q000706:statistics & numerical data*