O2068: Interventions to Reduce Treatment Abandonment in Children Diagnosed with Cancer in a Comprehensive Pediatric Cancer Center in Sub Saharan Africa

Purpose/Objectives: Treatment Abandonment(TA) is failure to start or complete curative therapy. In Sub-Saharan Africa, about 30% of children fail to start or complete treatment for a curable cancer and this is a major cause of poor survival rates.
Texas Children’s Hospital and Mulago National Referral Hospital, Uganda partnered in 2019 under the Global HOPE program to establish a comprehensive pediatric cancer treatment center in Kampala, Uganda, offering free cancer treatment and training of medical professionals.

The purpose of this project was to implement interventions to ensure children diagnosed with cancer at Mulago National Referral Hospital start and complete treatment.

Our objective was to reduce treatment abandonment in children diagnosed with cancer at Mulago National Referral Hospital to less than 3% by year 2023.

Design/Methods: This project included all children under 18 years diagnosed with cancer at Mulago National Referral Hospital, Uganda from January 2019 to December 2022.
Using a Plan, Do, Study, Act(PDSA) approach, we performed baseline evaluation on our initial cohort of children diagnosed between January 2019 and December 2019. We determined treatment abandonment rate, and reasons for abandoning treatment. All patients received free cancer diagnostics and treatment.
Due to the emergence of Coronavirus(COVID-19) pandemic, new interventions to ensure patients completed treatment were instituted and included provision of free accommodation, reimbursement of transport costs during hospital visits, or home-based treatment (including home visits by doctors and nurses, telephone reviews). Developed a tracking system that identifies patients who have missed appointments. We documented the treatment abandonment rate in a prospective cohort of children diagnosed between January 2020 and December 2022 at 1-year intervals.

Results: Initial Cohort included 230 patients diagnosed in 2019. Treatment abandonment rate was 5.2% (12/230). Of the 12 patients that abandoned treatment, 25%(3/12) had soft tissue sarcoma, 25%(3/12) had Lymphoma, 16.7%(2/12) had Acute Leukemia. Treatment was abandoned due to lack of transport money to hospital, or parent’s perception that cancer was incurable in one half (6/12) of patients and one quarter (3/12) of patients respectively.
Patients diagnosed in 2020, 2021 and 2022 were 248, 250 and 260 respectively with treatment abandonment rate of 5.6%(14/248), 6.4%(16/250), 2.7%(7/260) for the respective years. In 2022, of the 7 patients that abandoned treatment, 42.9%(3/7) was due to parent’s perception that the child had cured, 28.6%(2/7) opted for alternative treatment.

Conclusion/Discussion: Treatment abandonment reduced from 5.2% in 2019 to 2.7% in 2022. We achieved our aim of a low TA rate less than 3% by year 2023. This is due to access to medical care without out-of-pocket costs to families.
Due to COVID-19 pandemic lockdowns, treatment abandonment increased by 0.4% in 2020 and 1.2% in 2021.
Our next target is Zero percent treatment abandonment by year 2025 and this is achievable through global health partnerships.