Treatment abandonment in children with Wilms tumor at a national referral hospital in Uganda
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Jun 2024 · 1 min read
In brief
In brief
This Ugandan cohort study found that 45% of children with Wilms tumor abandoned treatment before completing neoadjuvant chemotherapy and surgery, with abandonment strongly associated with poor chemotherapy response and tumor size exceeding 25 cm. The findings highlight critical barriers to pediatric cancer care completion in resource-limited settings.
- 86% of Wilms tumor patients in Uganda started chemotherapy, but only 55% completed treatment through surgery—indicating high abandonment rates.
- Treatment abandonment was significantly associated with poor chemotherapy response (OR 4.70) and tumor size >25 cm (OR 2.67).
- 71% of patients presented with stage III or higher disease, suggesting late diagnosis contributes to poor outcomes and treatment discontinuation.
- Families are more likely to abandon care during neoadjuvant therapy when tumors show poor response, highlighting need for early intervention strategies.
- Addressing barriers to treatment completion requires understanding both clinical factors (tumor biology, response) and socioeconomic factors in resource-limited settings.
Written by the GCMD Library team from the article.
Abstract
Introduction
The incidence of pediatric Wilms’ tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda.
Methods
A cohort study of patients < 18 years with WT in a Ugandan national referral hospital examined clinical and treatment outcomes data, comparing children whose families adhered to and abandoned treatment. Abandonment was defined as the inability to complete neoadjuvant chemotherapy and surgery for patients with unilateral WT and definitive chemotherapy for patients with bilateral WT. Patient factors were assessed via bivariate logistic regression.
Results
137 WT patients were included from 2012 to 2017. The mean age was 3.9 years, 71% (n = 98) were stage III or higher. After diagnosis, 86% (n = 118) started neoadjuvant chemotherapy, 59% (n = 82) completed neoadjuvant therapy, and 55% (n = 75) adhered to treatment through surgery. Treatment abandonment was associated with poor chemotherapy response (odds ratio [OR] 4.70, 95% confidence interval [CI] 1.30–17.0) and tumor size > 25 cm (OR 2.67, 95% CI 1.05–6.81).
Conclusions
Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.