title: Parents' and health-care providers' perspectives on side- effects of childhood cancer treatment in Indonesia.
abstract: BACKGROUND
  Efficacy of childhood cancer treatment in low-income countries may be impacted by parents' and health-care providers' perspectives on chemotherapy-related side-effects. This study explores prevalence and severity of side-effects in childhood cancer, and compares health beliefs about side-effects between parents and health-care providers, and between nurses and doctors in Indonesia.
  
  
  METHODS
  Semi-structured questionnaires were filled in by 40 parents and 207 health-care providers in an academic hospital.
  
  
  RESULTS
  Parents exporessed a desire to receive more information about side-effects (98%) and worried about this aspect of treatment (90%), although side-effects were less severe than expected (66%). The most frequent was behavior alteration (98%) and the most severe was hair loss. Only 26% of parents consulted doctors about side-effects. More parents, compared to health-care providers, believed that medicines work better when side-effects are more severe (p<0.001), and accepted severe side-effects (p=0.021). More health-care providers, compared to parents, believed that chemotherapy can be stopped or the dosage altered when there are side-effects (p=0.011). More nurses, compared to doctors, stated that side-effects were unbearable (p=0.004) and made them doubt efficacy of treatment (p<0.001).
  
  
  CONCLUSIONS
  Behavior alteration is the most frequent and hair loss the most severe side-effect. Apparent discrepancies in health beliefs about side-effects exist between parents and health-care providers. A sustainable parental education program about side-effects is recommended. Health-care providers need to update and improve their knowledge and communication skills in order to give appropriate information. Such measures may improve outcome of childhood cancer treatment in low-income countries, where adherence to therapy is a major issue.
authors.affiliation: Department of Pediatric Oncology-Hematology, Prof Dr RD Kandou Hospital, Manado, Indonesia E-mail : s.mostert@vumc.nl.
authors.forename: Stefanus
authors.initials: S
authors.lastname: Gunawan
authors.forename: Emma
authors.initials: E
authors.lastname: Wolters
authors.forename: Josephine
authors.initials: J
authors.lastname: van Dongen
authors.forename: Peter
authors.initials: P
authors.lastname: van de Ven
authors.forename: Mei
authors.initials: M
authors.lastname: Sitaresmi
authors.forename: Anjo
authors.initials: A
authors.lastname: Veerman
authors.forename: Max
authors.initials: M
authors.lastname: Mantik
authors.forename: Gertjan
authors.initials: G
authors.lastname: Kaspers
authors.forename: Saskia
authors.initials: S
authors.lastname: Mostert
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D007214:Indonesia; D007223:Infant; D008297:Male; D008495:Medical Oncology; D009859:Oncology Nursing; D010290:Parents / Q000523:psychology*; D010371:Pediatric Nursing; D010372:Pediatrics
chemical_list: D000970:Antineoplastic Agents