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Sisk BA, Harvey K, Friedrich AB, Antes AL, Yaeger LH, Mack JW, DuBois J. Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review. Pediatr Blood Cancer 2022; 69:e29405. [PMID: 34662485 PMCID: PMC8875310 DOI: 10.1002/pbc.29405] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
Multiple factors can facilitate or impede the fulfillment of communication functions in pediatric cancer. In this systematic review, we evaluated 109 studies from the preceding 20 years that presented qualitative or quantitative evidence of barriers or facilitators to communication in pediatric cancer. Using a multilevel framework developed in our prior study, we then analyzed and categorized the levels of barriers and facilitators identified in included studies. The vast majority of studies focused on individual-level barriers, rather than team, organization/system, collaborating hospital, community, or policy-level barriers. Future studies should explore the full range of factors that affect communication.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kieandra Harvey
- Brown School of Social Work, Washington University School of Medicine, St. Louis, Missouri
| | - Annie B. Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri
| | - Alison L. Antes
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Kwon J, Kim SY, Yeob KE, Han HS, Lee KH, Shin DW, Kim YY, Park JH, Park JH, Kawachi I. Differences in diagnosis, treatment, and survival rate of acute myeloid leukemia with or without disabilities: A national cohort study in the Republic of Korea. Cancer Med 2020; 9:5335-5344. [PMID: 32491262 PMCID: PMC7402831 DOI: 10.1002/cam4.3179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/22/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
We analyzed the patterns of diagnosis, treatment, and prognoses of acute myeloid leukemia (AML) patients with and without disabilities. The data were collected from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claim database. We built a cohort of 2 776 450 people with disabilities and a nondisabled cohort of 8 329 350 people who were selected at a ratio of 1:3 by matching age and sex. From this population, adult patients who were diagnosed with AML were analyzed. The number of patients with AML were 26.74 per 100 000 in people without disabilities and 20.39 per 100 000 in those with disabilities (P < .0001). The proportion of AML patients receiving chemotherapy and those of patients receiving transplants were significantly lower in the disabled population than that of nondisabled populations (71.2% vs 77.1%, P = .0031, and 17.5% vs 26.9%, P = .002). This trend was more pronounced in subgroups of communication disability and major internal organ disorder. The median survival was 10.8 months for patients with disabilities, which was significantly shorter than 17.1 months for those without a disability (P = .002). Individuals with disabilities have a low diagnosis rate of AML and undergo less active treatment, which results in inferior prognosis.
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Affiliation(s)
- Jihyun Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - So Young Kim
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea.,T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kyoung Eun Yeob
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| | - Hye Sook Han
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Ki Hyeong Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Dong Wook Shin
- Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Jong Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea.,T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ichiro Kawachi
- T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Schröders J, Wall S, Kusnanto H, Ng N. Millennium development goal four and child health inequities in indonesia: a systematic review of the literature. PLoS One 2015; 10:e0123629. [PMID: 25942491 PMCID: PMC4420469 DOI: 10.1371/journal.pone.0123629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/05/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework? Methods and Findings We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities. Conclusion This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.
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Affiliation(s)
- Julia Schröders
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- * E-mail:
| | - Stig Wall
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hari Kusnanto
- Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Nawi Ng
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Petridou ET, Sergentanis TN, Perlepe C, Papathoma P, Tsilimidos G, Kontogeorgi E, Kourti M, Baka M, Moschovi M, Polychronopoulou S, Sidi V, Hatzipantelis E, Stiakaki E, Iliadou AN, La Vecchia C, Skalkidou A, Adami HO. Socioeconomic disparities in survival from childhood leukemia in the United States and globally: a meta-analysis. Ann Oncol 2015; 26:589-597. [PMID: 25527416 DOI: 10.1093/annonc/mdu572] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Despite advancements in the treatment of childhood leukemia, socioeconomic status (SES) may potentially affect disease prognosis. This study aims to evaluate whether SES is associated with survival from childhood leukemia. METHODS The US National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 1973-2010 data were analyzed; thereafter, results were meta-analyzed along with those from survival (cohort) studies examining the association between SES indices and survival from childhood leukemia (end-of-search date: 31 March 2014). Random-effects models were used to calculate pooled effect estimates (relative risks, RRs); meta-regression was also used. RESULTS We included 29 studies yielding 28 804 acute lymphoblastic leukemia (ALL), 3208 acute myeloblastic leukemia (AML) and 27 650 'any' leukemia (denoting joint reporting of all subtypes) cases. According to individual-level composite SES indices, children from low SES suffered from nearly twofold higher death rates from ALL (pooled RR: 1.83, 95% confidence interval 1.00-3.34, based on four study arms); likewise, death RRs derived from an array of lower area-level SES indices ranged between 1.17 and 1.33 (based on 11 study arms). Importantly, the survival gap between higher and lower SES seemed wider in the United States, with considerably (by 20%-82%) increased RRs for death from ALL in lower SES. Regarding AML, poorer survival was evident only when area-level SES indices were used. Lastly, remoteness indices were not associated with survival from childhood leukemia. CONCLUSION Children with lower SES suffering childhood leukemia do not seem to equally enjoy the impressive recent survival gains. Special health policy strategies and increased awareness of health providers might minimize the effects of socioeconomic disparities.
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Affiliation(s)
- E T Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - T N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - C Perlepe
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - P Papathoma
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - G Tsilimidos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - E Kontogeorgi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - M Kourti
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - M Baka
- Department of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital, Athens
| | - M Moschovi
- First Department of Pediatrics, Athens University Medical School
| | - S Polychronopoulou
- Department of Pediatric Hematology-Oncology, 'Aghia Sophia' General Children's Hospital, Athens
| | - V Sidi
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - E Hatzipantelis
- 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki
| | - E Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - A N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - A Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - H O Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Epidemiology, Harvard School of Public Health, Boston, USA
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Chen J, Liu Y, Cai QQ, Liu YM, Wang T, Zhang K, Wang JF, Chen WQ, Huang H. Type D personality parents of children with leukemia tend to experience anxiety: the mediating effects of social support and coping style. Medicine (Baltimore) 2015; 94:e627. [PMID: 25761192 PMCID: PMC4602458 DOI: 10.1097/md.0000000000000627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aims were to access anxiety and type D personality (TDP) in parents of children with leukemia, and to determine the mediating effect of social support and coping style on the relationship between TDP and anxiety. A cross-sectional study was conducted among 231 parents of children with leukemia and 261 parents of children with acute diseases in hospitals. Parents completed questionnaires on anxiety, TDP, social support, coping styles, children's clinical characteristics, and demographic characteristics. Parents of children with leukemia showed higher prevalence of anxiety (64.5% vs 40.2%, P < 0.01) and TDP (44.2% vs 24.1%, P < 0.01) compared with controls. TDP (odds ratio [OR] = 4.34, P < 0.01), lower social support (OR = 1.92, P = 0.02), and less positive coping (OR = 1.87, P = 0.02) were independently associated with anxiety. Parents with TDP showed lower social support and less positive coping, but more negative coping compared with those without. Moreover, multiple mediation analyses revealed that the significant effect of TDP on anxiety was partially mediated by social support and positive coping. In conclusion, anxiety and TDP were highly prevalent in parents of children with leukemia. The predictive factors could be used to identify those parents who are at high risk of anxiety and may also be targets for prevention and intervention.
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Affiliation(s)
- Jie Chen
- From the Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology (JC, YL, TW, KZ, JFW, HH); Sun Yat-sen Memorial Hospital of Sun Yat-sen University (JC, YL, YML, TW, KZ, JFW, HH); Department of Internal Medicine (QQC), Cancer Center; and Department of Biostatistics and Epidemiology (WQC), School of Public Health, Sun Yat-sen University, Guangzhou, China
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Gunawan S, Wolters E, van Dongen J, van de Ven P, Sitaresmi M, Veerman A, Mantik M, Kaspers G, Mostert S. Parents' and health-care providers' perspectives on side- effects of childhood cancer treatment in Indonesia. Asian Pac J Cancer Prev 2015; 15:3593-9. [PMID: 24870763 DOI: 10.7314/apjcp.2014.15.8.3593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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. MATERIALS AND 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.
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Affiliation(s)
- Stefanus Gunawan
- Department of Pediatric Oncology-Hematology, Prof Dr RD Kandou Hospital, Manado, Indonesia E-mail :
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Mostert S, Njuguna F, Langat SC, Slot AJM, Skiles J, Sitaresmi MN, van de Ven PM, Musimbi J, Vreeman RC, Kaspers GJL. Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: parents' social network and experiences with hospital retention policies. Psychooncology 2014; 23:700-7. [DOI: 10.1002/pon.3571] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/11/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022]
Affiliation(s)
- S. Mostert
- Department of Pediatric Oncology/Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - F. Njuguna
- Department of Pediatrics; Moi Teaching and Referral Hospital; Eldoret Kenya
| | - S. C. Langat
- Department of Pediatrics; Moi Teaching and Referral Hospital; Eldoret Kenya
| | - A. J. M. Slot
- Department of Pediatric Oncology/Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - J. Skiles
- Department of Pediatrics; Indiana University School of Medicine; Indianapolis IN USA
| | - M. N. Sitaresmi
- Department of Pediatrics; Dr. Sardjito Hospital; Yogyakarta Indonesia
| | - P. M. van de Ven
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam The Netherlands
| | - J. Musimbi
- Department of Pediatrics; Moi Teaching and Referral Hospital; Eldoret Kenya
| | - R. C. Vreeman
- Department of Pediatrics; Indiana University School of Medicine; Indianapolis IN USA
| | - G. J. L. Kaspers
- Department of Pediatric Oncology/Hematology; VU University Medical Center; Amsterdam The Netherlands
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Denburg AE, Knaul FM, Atun R, Frazier LA, Barr RD. Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes. Pediatr Blood Cancer 2014; 61:572-6. [PMID: 24249518 DOI: 10.1002/pbc.24858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022]
Abstract
Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions.
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Affiliation(s)
- Avram E Denburg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dana-Farber Children's Cancer Center, Boston, Massachusetts; Harvard Global Equity Initiative, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
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Sitaresmi MN, Mostert S, Gundy CM, Ismail D, Veerman AJP. A medication diary-book for pediatric patients with acute lymphoblastic leukemia in Indonesia. Pediatr Blood Cancer 2013; 60:1593-7. [PMID: 23733528 DOI: 10.1002/pbc.24570] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Event-free survival of pediatric patients with acute lymphoblastic leukemia (ALL) in Yogyakarta, Indonesia was low (20%). The aim of the study was to evaluate the effectiveness of using a medication diary-book on the treatment outcome of childhood ALL. PROCEDURE A randomized study was conducted with 109 pediatric patients with ALL in a pediatric oncology center in Yogyakarta, Indonesia. Both intervention and control groups received a structured parental education program and donated chemotherapy. The intervention group received a medication diary-book to remind parents and families to take oral chemotherapy and present for scheduled appointments or admissions. Event-free survival estimate (EFS) at 3 years was assessed. RESULTS Among pediatric patients with ALL with highly educated mothers (senior high school or higher), the EFS-estimate at 3 years of the intervention group was significantly higher than the EFS-estimate at 3 years of the control group (62% vs. 29%, P = 0.04). Among pediatric patients with ALL with low-educated mothers, no significant difference was found in the EFS-estimates at 3 years between the intervention and control group (26% vs. 18%, P = 0.86). CONCLUSIONS We conclude that a medication diary-book might be useful to improve the survival of pediatric patients with ALL in resource-limited settings, particularly in patients with highly educated mothers.
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Affiliation(s)
- Mei N Sitaresmi
- Department of Pediatrics, Dr Sardjito Hospital, Yogyakarta, Indonesia
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Mostert S, Gunawan S, van Dongen JAP, van de Ven PM, Sitaresmi MN, Wolters EE, Veerman AJP, Mantik M, Kaspers GJL. Health-care providers' perspectives on childhood cancer treatment in Manado, Indonesia. Psychooncology 2013; 22:2522-8. [DOI: 10.1002/pon.3314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 04/26/2013] [Accepted: 04/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- S. Mostert
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - S. Gunawan
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - J. A. P. van Dongen
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - P. M. van de Ven
- Epidemiology and Biostatistics; VU University Medical Center; Amsterdam The Netherlands
| | - M. N. Sitaresmi
- Department of Pediatrics, Dr Sardjito Hospital; Gadjah Mada University; Yogyakarta Indonesia
| | - E. E. Wolters
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - A. J. P. Veerman
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - M. Mantik
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - G. J. L. Kaspers
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
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de Oliveira BM, Valadares MTM, Silva MR, Viana MB. Compliance with a protocol for acute lymphoblastic leukemia in childhood. Rev Bras Hematol Hemoter 2012; 33:185-9. [PMID: 23049293 PMCID: PMC3415741 DOI: 10.5581/1516-8484.20110051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 03/09/2011] [Indexed: 12/13/2022] Open
Abstract
Background Remission rates achieved after the initial treatment of acute lymphoblastic leukemia may be similar in both developed and developing countries, but relapse rates are much higher in the latter. Thus, other reasons are needed, in addition to biological characteristics of the leukemic cells themselves, to explain the unfavorable evolution of patients living in unfavorable socioeconomic and cultural conditions. Objective The aim of this study was to retrospectively evaluate compliance to an acute lymphoblastic leukemia treatment protocol. Methods Main abstracted data were: total duration and reasons for interruption of chemotherapy, prescribed doses of 6-mercaptopurine, and median white blood cell and neutrophil counts during the maintenance phase. Interruptions of chemotherapy were considered inappropriate if they did not follow predetermined criteria established in the protocol. Results Fourteen of 73 patients (19.2%) unduly interrupted chemotherapy by determination of their physicians. The median white blood cell count was higher when compared with the protocol recommendations; the median 6-MP dose was lower than the standard recommended dose. The estimated probability of event-free survival was higher for patients with lower median leukocyte counts and close to those predetermined by the protocol. Event-free survival was also higher for children with a higher percentage of days without chemotherapy due to bone marrow or liver toxicity excluding undue interruptions. In multivariate analysis, both factors remained statistically significant. These results suggest that the intensity of maintenance chemotherapy may not have been enough in some children, to achieve adequate myelosuppression, hence the observation of higher leukocyte counts and none or rare episodes of therapy interruption. Conclusions Compliance to the therapeutic protocol by both doctors and patients should always be considered in the evaluation of therapeutic failure in acute lymphoblastic leukemia; strict adherence to treatment protocols contributes to better treatment results in acute lymphoblastic leukemia children.
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Affiliation(s)
- Benigna Maria de Oliveira
- Pediatrics Department, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil
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Ota MOC, Idoko OT, Ogundare EO, Afolabi MO. Human immune responses to vaccines in the first year of life: biological, socio-economic and ethical issues - a viewpoint. Vaccine 2012; 31:2483-8. [PMID: 22728219 DOI: 10.1016/j.vaccine.2012.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/08/2012] [Accepted: 06/06/2012] [Indexed: 12/31/2022]
Abstract
Human newborns are vulnerable to infectious diseases that account for majority of the morbidity and mortality, particularly in first year of life. Vaccines have become the most effective public health intervention strategy to curtail the prevalence of these infectious diseases. Although vaccines against a number of diseases exist, there are no vaccines against many other diseases that commonly affect children. The adequate assessment of immune responses to vaccines is an important step in the development of vaccines. However, a number of biological and "non-medical" socio-economic and ethical factors could influence either the administration and/or evaluation of vaccines in infants. Recognition and understanding of these determinants are crucial in planning interventions and for logical interpretations of results.
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Affiliation(s)
- M O C Ota
- Vaccinology Theme, Medical Research Council MRC Unit, Banjul, Gambia.
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Syse A, Lyngstad TH, Kravdal O. Is mortality after childhood cancer dependent on social or economic resources of parents? A population-based study. Int J Cancer 2011; 130:1870-8. [DOI: 10.1002/ijc.26186] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/02/2011] [Indexed: 11/05/2022]
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Chantada GL. Retinoblastoma: Lessons and challenges from developing countries. Ellsworth Lecture 2011. Ophthalmic Genet 2011; 32:196-203. [PMID: 21770696 DOI: 10.3109/13816810.2011.592173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2011; 47:1005-10. [PMID: 21220796 DOI: 10.1007/s13312-010-0172-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Treatment refusal and abandonment is the principal cause of therapy failure in children with cancer in the developing world. A complex interplay of biological, socio-economic and treatment-related factors underlies this problem. Interventions are likely to succeed when they try and address all of these issues simultaneously, as exemplified by the success of twinning programs linking resource-rich and resource-limited countries. Hitherto, there has been no systematic attempt to understand and address this problem in India. Based on the knowledge gained from research in other parts of the developing world, we offer suggestions for dealing with this problem.
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Affiliation(s)
- R S Arora
- Cancer Research UK Paediatric and Familial Cancer Research Group, University of Manchester, Manchester, UK.
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Bonilla M, Gupta S, Vasquez R, Fuentes SL, deReyes G, Ribeiro R, Sung L. Predictors of outcome and methodological issues in children with acute lymphoblastic leukaemia in El Salvador. Eur J Cancer 2010; 46:3280-6. [DOI: 10.1016/j.ejca.2010.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/22/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
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Kong KA, Khang YH, Cha ES, Moon EK, Lee YH, Lee WJ. Childhood cancer mortality and socioeconomic position in South Korea: a national population-based birth cohort study. Cancer Causes Control 2010; 21:1559-67. [PMID: 20512527 DOI: 10.1007/s10552-010-9584-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
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Mostert S, Sitaresmi MN, Gundy CM, Sutaryo, Veerman AJ. Does aid reach the poor? Experiences of a childhood leukaemia outreach-programme. Eur J Cancer 2009; 45:414-9. [DOI: 10.1016/j.ejca.2008.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/30/2008] [Accepted: 09/25/2008] [Indexed: 11/29/2022]
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Abstract
In our study, we examined socioeconomic, treatment-related, and psychologic experiences of parents during the acute lymphoblastic leukemia treatment of their children in an academic hospital in Indonesia. Children were treated with the WK-ALL-2000 protocol and received donated chemotherapy. From November 2004 to April 2006, 51 parents were interviewed by psychologists using semi-structured questionnaires. The family income had decreased (69%) since the start of treatment. Parents lost their jobs (29% of fathers and 8% of mothers), most of whom stated that this loss of employment was caused by the leukemia of their child (87% of fathers and 100% of mothers). Treatment costs resulted in financial difficulties (78%), debts (65%), and forced parents either to postpone or withdraw from parts of treatment (18%). Parents mentioned needing more information (86%) from and contact (77%) with doctors. The parent organization did not pay any visits (69%) during hospitalization, nor did they give information (59%) or emotional support (55%). We have concluded that the socioeconomic impact of leukemia treatment was profound. Communication between parents and doctors requires improving. The role of the parent organization was insignificant and must be ameliorated.
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