title: Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia.
abstract: BACKGROUND
  There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.
  
  
  METHODS
  Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.
  
  
  RESULTS
  Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR]  = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58).
  
  
  CONCLUSIONS
  Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Slone
authors.affiliation: Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chunda-Liyoka
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Marta
authors.initials: M
authors.lastname: Perez
authors.affiliation: Epidemiology and Cancer Statistics Group, University of York, York, England, United Kingdom.
authors.forename: Nora
authors.initials: N
authors.lastname: Mutalima
authors.affiliation: Epidemiology and Cancer Statistics Group, University of York, York, England, United Kingdom ; Medical Research Council/Uganda Virus Research Institute Research Unit on Acquired Immune Deficiency Syndrome (AIDS), Entebbe, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Newton
authors.affiliation: Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Chifumbe
authors.initials: C
authors.lastname: Chintu
authors.affiliation: Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.affiliation: Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: James
authors.initials: J
authors.lastname: Chipeta
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America ; Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Heimburger
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America ; Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America ; Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America ; Vanderbilt-Ingram Cancer Center; Nashville, Tennessee, United States of America.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy*; D016017:Odds Ratio; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology