Interventions targeting absences increase adherence and reduce abandonment of childhood cancer treatment in El Salvador.
BACKGROUND
In El Salvador, about 200 new cases of pediatric cancer are diagnosed each year, and survival rates approach 70%. Although treatment is available at no cost, abandonment of therapy has remained at a steady yearly rate of 13% during the past decade. A time sensitive adherence tracking procedure (TS-ATP) was recently implemented to detect missed appointments, identify their causes, and intervene promptly. Procedure The study team was informed daily of patient/family failure to attend medical appointments in the pediatric oncology unit; the families were contacted and interviewed to ascertain and address the reasons. Patients who did not return after this initial contact were contacted again through local health clinics and municipalities. Law enforcement was a last resort for patients undergoing frontline treatment with a good prognosis., The system was adapted to clinical urgency: families of patients undergoing induction therapy were contacted within 24 hr, those in other therapy phases, within 48 hr, and those who had completed treatment, within one week. Reasons for absence were obtained by telephone or in person.


RESULTS
The annual rate of abandonment was reduced from 13-3% during the 2 years period. There were 1,111 absences reported and 1,472 contacts with caregivers and institutions. The three main reasons for absences were financial needs (165, 23%), unforeseen barriers (116, 16%), and domestic needs (86, 12%).


CONCLUSIONS
Use of the treatment adherence tracking system to locate and communicate with patients/families after missed appointments and the allocated aid stemming from these interviews substantially reduced abandonment and non-adherence.
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.
Carmen
C
Salaverria
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.|Amsterdam Institute for Social Sciences Research (AISSR), Amsterdam University, the Netherlands.
Nuria
N
Rossell
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.
Angelica
A
Hernandez
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.
Soad
S
Fuentes Alabi
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.
Roberto
R
Vasquez
International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tenesse.
Miguel
M
Bonilla
International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tenesse.|Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tenesse.|University of Tennessee, College of Medicine, Memphis, Tenesse.
Catherine G
CG
Lam
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tenesse.|University of Tennessee, College of Medicine, Memphis, Tenesse.
Raul C
RC
Ribeiro
D000293:Adolescent; D002173:Cancer Care Facilities / Q000458:organization & administration; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004544:El Salvador / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007223:Infant; D035846:Law Enforcement; D008297:Male; D009042:Motivation; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D016522:Oncology Service, Hospital / Q000458:organization & administration; D010349:Patient Compliance; D010352:Patient Dropouts / Q000331:legislation & jurisprudence / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010565:Persuasive Communication; D011203:Poverty; D011368:Professional-Family Relations; D012948:Social Work Department, Hospital / Q000458:organization & administration; D013689:Telephone; D062606:Tertiary Care Centers / Q000458:organization & administration; D013997:Time Factors; D016312:Treatment Refusal / Q000331:legislation & jurisprudence / Q000523:psychology* / Q000706:statistics & numerical data
adherence; childhood cancer; developing countries; patient tracking; treatment abandonment