title: Tracking children with acute lymphoblastic leukemia who abandoned therapy: Experience, challenges, parental perspectives, and impact of treatment subsidies and intensified counseling.
abstract: Refusal for treatment and therapy abandonment are important reasons for unfavorable outcome of childhood acute lymphoblastic leukemia (ALL) in resource-poor countries. The present study, conducted on children with ALL whose treatment was abandoned, attempted to track all these children to ascertain the causes and outcome of therapy abandonment/refusal. In order to improve outcome of ALL, measures to prevent abandonment were introduced in the form of treatment subsidies and intensified multistage counseling. Of the 77 (of 418) children abandoning therapy, 17 (22%) refused upfront, whereas the rest abandoned during various phases of chemotherapy. Only 39 (50.6%) of these 77 families could be subsequently contacted. Financial problems, too many dependents at home, and wrong perceptions about cancer led to abandonment in majority. Children abandoning treatment before completion of induction had a significantly shorter survival than who abandoned post induction (P < .0001). Intensified preabandonment counseling and subsidized treatment led to significant reduction in abandonment rates (P < .0001).
authors.affiliation: a Department of Pediatrics , King George's Medical University , Lucknow , India.
authors.forename: Nirmalya
authors.initials: N
authors.lastname: Roy Moulik
authors.affiliation: b Division of Hematology/Oncology , Department of Pediatrics , IWK Health Centre , Halifax , Canada.
authors.forename: Ketan Prasad
authors.initials: KP
authors.lastname: Kulkarni
authors.affiliation: c Division of Pediatric Hematology-Oncology , Department of Pediatrics , King George's Medical University , Lucknow , India.
authors.forename: Archana
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D012959:Socioeconomic Factors; D016312:Treatment Refusal
keywords: Abandonment; childhood ALL; interventions