title: A systematic review of factors that influence treatment adherence in paediatric oncology patients.
abstract: OBJECTIVE
  Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population.
  
  
  METHODS
  A literature search was carried out using related keywords on electronic databases.
  
  
  CONCLUSIONS
  A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention.
  
  
  CONCLUSIONS
  Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: X T W
authors.initials: XT
authors.lastname: Goh
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Y B
authors.initials: YB
authors.lastname: Tan
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.|Centre for Medical Ethics and Professionalism at Singapore Medical Association, Singapore, Singapore.
authors.forename: T
authors.initials: T
authors.lastname: Thirumoorthy
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Y H
authors.identifier: http://orcid.org/0000-0001-7802-9696
authors.initials: YH
authors.lastname: Kwan
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000628:therapy*; D010372:Pediatrics; D016903:Drug Monitoring
keywords: adherence; compliance; factors; oncology; paediatric