Treatment Abandonment: Cause of Preventable Death in Children with Cancer
Keywords:
Neoplasms, child, abandoned, therapy, survival, developed countries, developing countriesAbstract
Objective: A cohort of children with cancer was analyzed to determine the risks of relapse or death in patients who abandoned treatment, as well as to explore causes for abandonment.
Methods: A retrospective cohort study was carried out with 303 patients, under age 23, from January 1998 to December 2000. Data were obtained from medical records and a telephone survey. Descriptive statistics were used to determine frequencies of category variables; contingency tables and calculation of the test, or the Exact Fisher Test, determined the association of variables with abandonment, in cases which did not fulfill Chi2 suppositions. Hazard ratio (HR) of treatment failure was calculated with the Cox regression model and survival analysis with the Kaplan-Meier method.
Results: A total of 17.87% patients abandoned treatment. Relapse and mortality were associated with treatment failure (P=0.001). Bivariate analysis revealed that the risks of relapse and abandonment were the only variables associated with development of event. Adjusted HR for abandonment and relapse risk was 3.90 (CI 95%; 2.27-6.77) and 2.24 (CI 95%; 1.29-3.88), respectively. The remaining variable showed no significant results.
Conclusions: Treatment abandonment at 17.87% is high compared to developed countries, and reveals an accentuated tendency to be associated with relapse and death.
Author Biographies
Amaranto Suárez, Instituto Nacional de Cancerología
Clínica de Oncología Pediátrica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Carolina Guzmán, Instituto Nacional de Cancerología
Clínica de Oncología Pediátrica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Bibiana Villa, Instituto Nacional de Cancerología
Clínica de Oncología Pediátrica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Óscar Gamboa, Instituto Nacional de Cancerología
Subdirección de Investigaciones, Vigilancia Epidemiológica, Promoción y Prevención, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
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