Prevalence and factors associated with treatment abandonment among children undergoing cancer therapy at Uganda Cancer Institute.

Abstract

Background: Treatment abandonment (TA) is a major contributor to treatment failure and poor treatment outcomes for children with cancer in low and middle-income countries (LMICs). However, there is limited literature on the prevalence of TA in these countries. Study objective: To assess the prevalence and factors associated with treatment abandonment among children aged 1-17 years undergoing cancer therapy at Uganda Cancer Institute. Methods: Explanatory sequential two-phase design study was conducted. Quantitative methods were a retrospective cross-sectional study of 352 children 1-17 years diagnosed with cancer at the Uganda Cancer Institute between June 2023 and August 2023, the qualitative methods were in-depth interviews with 12 caregivers, and 8 key informant interviews with staff at UCI. Quantitative data was analysed using STATA version 15.0, and qualitative data was manually analysed using inductive thematic analysis Results: Of the 335 (58.2% males) patients recruited, 79.4% have 0-5 siblings, 71.3% were attended to by peasant caregivers, and 63.9% were cared for by biological parents. The prevalence of TA was 191/335 (57%). Children from a family of at least 6 siblings increased the risk of TA by 10% compared to children with 0 to 5 siblings (APOR=1.1, 95% CI: 1.1–1.2). Children who had peasant attendants had a 9% chance of experiencing treatment abandonment more than those with other occupations (APOR=1.09, 95%CI: 1.01-1.18). Coming from Northern Uganda increased the risk of TA by 15% compared to being in the Central region (APOR=1.15, 95% CI: 1.05–1.26). Key informants agree that TA is indeed a major problem among child patients on treatment at the UCI. Both caregivers, and key informants highlighted long distances from the health facility, large family size, financial constraints, treatment side effects, community influence, and alternative medicine as the main reasons for TA.Conclusion: Treatment abandonment is a major problem among children undergoing cancer therapy at the UCI. The study identified long distances from health facility (UCI), large family size characterised by many children and extended family, and financial constraints as the key factors associated with TA. Operationalization of regional centres and psychosocial support can help reduce the rate of TA.