Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: parents' social network and experiences with hospital retention policies.
BACKGROUND
The principal reason for childhood cancer treatment failure in low-income countries is treatment abandonment, the most severe form of nonadherence. Two often neglected factors that may contribute to treatment abandonment are as follows: (a) lack of information and guidance by doctors, along with the negative beliefs of family and friends advising parents, which contributes to misconceptions regarding cancer and its treatment, and (b) a widespread policy in public hospitals by which children are retained after doctor's discharge until medical bills are settled.


OBJECTIVE
This study explored parents' experiences with hospital retention policies in a Kenyan academic hospital and the impact of attitudes of family and friends on parents' decisions about continuing cancer treatment for their child.


METHODS
Home visits were conducted to interview parents of childhood cancer patients who had been diagnosed between 2007 and 2009 and who had abandoned cancer treatment.


RESULTS
Retrospective chart review revealed 98 children diagnosed between 2007 and 2009 whose parents had made the decisions to abandon treatment. During 2011-2012, 53 families (54%) could be reached, and 46 (87%) of these agreed to be interviewed. Parents reported the attitudes of community members (grandparents, relatives, friends, villagers, and church members); 61% believed that the child had been bewitched by some individual, and 74% advised parents to seek alternative treatment or advised them to stop medical treatment (54%). Parents also reported that they were influenced by discussions with other parents who had a child being treated, including that their child's life was in God's hands (87%), the trauma to the child and family of forced hospital stays (84%), the importance of completing treatment (81%), the financial burden of treatment (77%), and the incurability of cancer (74%). These discussions influenced their perceptions of cancer treatment and its usefulness (65%). Thirty-six families (78%) had no health insurance, and 19 of these parents (53%) could not pay their medical bills and were not allowed to take their child home when treatment ended. Parents reported feelings of desperation (95%), powerlessness (95%), and sadness (84%) and that their child has been imprisoned (80%), during the period of retention. The majority of parents (87%) felt that hospital retention of children must cease.


CONCLUSIONS
The attitudes and beliefs of parents of children with cancer are impacted by those close to them and their community and may influence their perceptions of cancer treatment and decisions to stop treatment. Hospital retention policies are highly distressing for parents and may contribute to both treatment delays and treatment abandonment. These factors jeopardize treatment outcomes for young patients and require attention and modification.
Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.
S
S
Mostert
F
F
Njuguna
S C
SC
Langat
A J M
AJ
Slot
J
J
Skiles
M N
MN
Sitaresmi
P M
PM
van de Ven
J
J
Musimbi
R C
RC
Vreeman
G J L
GJ
Kaspers
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D010351:Patient Discharge; D010353:Patient Education as Topic; D011368:Professional-Family Relations; D012944:Social Support
adherence; childhood cancer; hospital retention policies; low-income countries; social network