SEATTLE — Each year, about 175,000 children aged 14 and under are diagnosed with cancer worldwide. According to the Union for International Cancer Control, 90,000 of these children – or eight children per 10 – die unnecessarily of their disease. Though advances in treatment have increased the survival rate of children diagnosed with cancer by 80 percent, most children with cancer live in developing countries have a survival rate of less than 25 percent.
A study conducted in Western Kenya sought to discern reasons for abandoning childhood cancer treatment in developing countries. Treatment abandonment is defined as failing to return to hospital for more than four weeks for scheduled appointments.
The most common forms of cancer in sub-Saharan Africa are non-Hodgkins lymphoma, kindney cancer and cancer of the bone marrow. Resource limitations in Africa prevent early, accurate diagnoses and affect adequate treatment and follow-up care support; children are particularly affected.
According to AfrOx, a nonprofit organization that helps African countries in implementing cancer prevention and control programs, only 5 percent of diagnosed cancers in children in Africa are cured compared to 80 percent in the rest of the world. With life-saving radiotherapy available to less than 20 percent of the population in Africa, contracting cancer is effectively a death sentence. The organization also notes that sustainable livelihood in the continent is severely hampered by the combined effects of cancer, poverty and infectious diseases.
Childhood Cancer Treatment
Childhood cancer is often left undiagnosed in developing countries due to a lack of awareness in less-educated populations, dwindling health budgets and absence of specialized health care workers. The Kenya study revealed the most common reasons for discontinued childhood cancer treatment to be financial difficulties (46 percent), lack of health insurance (27 percent) and transport difficulties (23 percent).
About 73 percent of the patients had abandoned treatment after first 3 months of treatment, of which only 20 percent were later alive. The means that four out of every five children died by the time the survey was conducted.
Prevention of Abandoning Childhood Cancer Treatment in Developing Countries
The study concluded that preventing childhood treatment abandonment required greater awareness and psychosocial guidance, adequate financial and transportation supports and further investments in the country’s health care resources for diagnosis and treatment of cancer in children.
Raul C. Ribeiro, MD, director of the International Outreach Program at St. Jude Children’s Research Hospital, which has partnered with local public hospitals offering pediatric oncology in developing countries and incorporated the model in its program, explained the extent the of the problem.
“In many countries, cancer is like a death sentence,” Ribeiro said. “When we started this program, as many as 40 percent of families in some countries abandoned treatment. In talking to other people in the community whose children had been successfully treated, little by little, that perspective changed.”
Families most often are discouraged in continuing cancer treatment for their children due to financial constraints. For instance, with a family income of about 44 dollars per household, Kenyan families agonize over choosing the lives of their children and putting food on the table.
Lack of health insurance is widespread, with over 50 percent of families surveyed failing to apply for health insurance due to mandatory premium payments. Living on less than a dollar a day, most of the patients’ families were farmers who could not afford the three dollar per hospital visit transportation expenses.
Mistrust of the Healthcare System
A general negative attitude in the prospect for survival also prevailed among families and communities. Mistrust of the healthcare system, fear of side effects of chemotherapy and surgery treatments and a long waiting period were all contributing factors in families abandoning cancer treatment for their own children.
Further advocacy and public awareness campaigns are sorely needed to tackle childhood cancers and continuing treatment. International twinning programs aiming to develop pediatric oncology services in developing countries have been a promising strategy in the past.
These programs can help enhance capacity of the hospitals and increase patient survival. Additionally, governments of developing countries including Kenya should enroll more citizens in health insurance so that all children diagnosed with cancer can seek proper treatment in public health facilities.
With these steps, childhood cancer treatment in developing countries can be carried out more effectively. Abandoning treatment means abandoning children — a choice no family anywhere should be forced to make.
– Mohammed Khalid