TY - JOUR
T1 - Treatment abandonment in children with Wilms tumor at a national referral hospital in Uganda
AU - Nanteza, Sumayiya
AU - Yap, Ava
AU - Stephens, Caroline Q.
AU - Kambagu, Joyce Balagadde
AU - Kisa, Phyllis
AU - Kakembo, Nasser
AU - Fadil, Geriga
AU - Nimanya, Stella A.
AU - Okello, Innocent
AU - Naluyimbazi, Rovine
AU - Mbwali, Fiona
AU - Kayima, Peter
AU - Ssewanyana, Yasin
AU - Grabski, David
AU - Naik-Mathuria, Bindi
AU - Langer, Monica
AU - Ozgediz, Doruk
AU - Sekabira, John
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - 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.
AB - 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.
KW - Global surgery
KW - Low–middle income country
KW - Pediatric oncology
KW - Pediatric surgery
KW - Treatment abandonment
KW - Wilms tumor
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U2 - 10.1007/s00383-024-05744-7
DO - 10.1007/s00383-024-05744-7
M3 - Article
C2 - 38926234
AN - SCOPUS:85197190861
SN - 0179-0358
VL - 40
JO - Pediatric Surgery International
JF - Pediatric Surgery International
IS - 1
M1 - 162
ER -