Treatment Abandonment in Children with Cancer in Sub-Saharan Africa: Systematic Literature Review and Meta-analysis

Aims: To establish and quantify the main reasons for treatment abandonment in children with cancer in Sub-Saharan Africa through a systematic review of the literature.

Background: Great advances have been made in the treatment of childhood cancer, however this requires that families are able to complete treatment. Failure to do this is referred to as treatment abandonment, which is recognized as a reason for treatment failure.

Design: Systematic review and meta-analysis of data on the reasons for treatment abandonment in Sub-Saharan Africa.

Data Sources: Ovid MEDLINE 1946 to May Week 1 2017 and Embase 1974 to 2017 Week 19. Additional hand-searching was undertaken.

Review Methods: Two reviewers independently screened papers and extracted the data. The R package meta was used to calculate the relative risk of treatment abandonment or the proportion of parents stating a reason.

Results: The relative risk of treatment abandonment was highest for not being in a research cohort; followed by mothers only having primary education, being HIV negative, parents not being employed, travel and no insurance. When parents who had abandoned treatment were asked, the most common reason was finance, followed by insurance, transport, lack of social support, their child appearing well, fear and waiting.

Conclusions: More data are needed on the extent of treatment abandonment in different countries. Clinicians should encourage parents without insurance to enrol onto the relevant insurance programme straight after diagnosis, provide housing for patients and families close to the treatment centres and to develop treatment at more localized centres.