title: Socio-economic status plays important roles in childhood cancer treatment outcome in Indonesia.
abstract: BACKGROUND
  The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital.
  
  
  METHODS
  Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires.
  
  
  RESULTS
  Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/ relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%).
  
  
  CONCLUSIONS
  Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed.
authors: Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands. s.mostert@vumc.nl
authors: Saskia
authors: S
authors: Mostert
authors: Stefanus
authors: S
authors: Gunawan
authors: Emma
authors: E
authors: Wolters
authors: Peter
authors: P
authors: van de Ven
authors: Mei
authors: M
authors: Sitaresmi
authors: Josephine van
authors: Jv
authors: Dongen
authors: Anjo
authors: A
authors: Veerman
authors: Max
authors: M
authors: Mantik
authors: Gertjan
authors: G
authors: Kaspers
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007182:Income; D007214:Indonesia; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010290:Parents; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome