Majid NADERI, Samira ESMAEILI REYKANDE, Shadi TABIBIAN, Shaban ALIZADEH, Akbar DORGALALEH, Morteza SHAMSIZADEH

Childhood acute lymphoblastic leukemia: refusal and abandonmentof treatment in the southeast of Iran

Background/aim: Acute lymphoblastic leukemia (ALL) accounts for 25% of all malignancies in children. ALL treatment has standard protocols, and treatment abandonment is a main cause of treatment failure. Therefore, this study aimed to assess the relationship between socioeconomic status and rate as well as cause of abandoned treatment in children with ALL in the southeast of Iran. Materials and methods: This retrospective, descriptive cohort study was conducted with ALL patients at the Ali Asghar Hospital in the city of Zahedan. The study population included 22 children with different subtypes of ALL who had abandoned their treatment. A structural questionnaire was filled out by patients or their parents. Results were assessed using descriptive and analytical tests. Results: The rate of treatment abandonment was 24.4% (22 patients).We had 18 ALL-L1 (78.3%) and four ALL-L2 (17.4%) patients. Reasons for treatment abandonment were low family income, transportation difficulties, the father s education status, conviction about ALL s incurability, and reference to spiritual means, respectively. Conclusion: Low family income, transportation difficulties, the father s education status, belief about ALL s incurability, and reference to spiritual means were the most common associations with ALL treatment abandonment in that order. Financial problems in this part of the country can impose high costs to the healthcare system.

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1. Gaynon PS, Qu RP, Chappell RJ, Willoughby ML, Tubergen DG, Steinherz PG, Trigg ME. Survival after relapse in childhood acute lymphoblastic leukemia. Cancer 1998; 82: 1387-1395.
2. Mostert S, Sitaresmi MN, Gundy CM, Veerman AJ. Influence of socioeconomic status on childhood acute lymphoblastic leukemia treatment in Indonesia. Pediatrics 2006; 118: e1600-e1606.
3. Mostert S, Sitaresmi MN, Gundy CM, Veerman AJ. Attitude of health‐care providers toward childhood leukemia patients with different socio‐economic status. Pediatr Blood Cancer 2008; 50: 1001-1005.
4. Hongo T, Yajima S, Sakurai M, Horikoshi Y, Hanada R. In vitro drug sensitivity testing can predict induction failure and early relapse of childhood acute lymphoblastic leukemia. Blood 1997; 89: 2959-2965.
5. Nguyen K, Devidas M, Cheng SC, La M, Raetz EA, Carroll WL, Winick NJ, Hunger SP, Gaynon PS, Loh ML. Factors influencing survival after relapse from acute lymphoblastic leukemia: a Childrens Oncology Group study. Leukemia 2008; 22: 2142-2150.
6. Njuguna F, Mostert S, Slot A, Langat S, Skiles J, Sitaresmi MN, van de Ven PM, Musimbi J, Muliro H, Vreeman RC et al. Abandonment of childhood cancer treatment in Western Kenya. Arch Dis Child 2014; 99: 609-614.
7. Bonilla M, Rossell N, Salaverria C, Gupta S, Barr R, Sala A, Metzger ML, Sung L. Prevalence and predictors of abandonment of therapy among children with cancer in El Salvador. Int J Cancer 2009; 125: 2144-2146.
8. Sitaresmi MN, Mostert S, Schook RM, Veerman AJ. Treatment refusal and abandonment in childhood acute lymphoblastic leukemia in Indonesia: an analysis of causes and consequences. Psycho‐Oncology 2010; 19: 361-367.
9. Oliveira BMd, Valadares MTM, Silva MR, Viana MB. Compliance with a protocol for acute lymphoblastic leukemia in childhood. Rev Bras Hematol Hemoter 2011; 33: 185-189.
10. Lightfoot TJ, Johnston WT, Simpson J, Smith AG, Ansell P, Crouch S, Roman E, Kinsey SE. Survival from childhood acute lymphoblastic leukaemia: the impact of social inequality in the United Kingdom. Eur J Cancer 2012; 48: 263-269.
11. Adam M, Rebholz CE, Egger M, Zwahlen M, Kuehni CE. Childhood leukaemia and socioeconomic status: what is the evidence? Radiat Prot Dosimetry 2008; 132: 246-254.
12. Erdmann F, Kaatsch P, Zeeb H, Roman E, Lightfoot T, Schüz J. Survival from childhood acute lymphoblastic leukaemia in West Germany: Does socio-demographic background matter? Eur J Cancer 2014; 50: 1345-1353.
13. Poole C, Greenland S, Luetters C, Kelsey JL, Mezei G. Socioeconomic status and childhood leukaemia: a review. Int J Epidemiol 2006; 35: 370-384.
14. Smith A, Roman E, Simpson J, Ansell P, Fear NT, Eden T. Childhood leukaemia and socioeconomic status: fact or artefact? A report from the United Kingdom childhood cancer study (UKCCS). Int J Epidemiol 2006; 35: 1504-1513.
15. Hoffbrand AV, Catovsky D, Tuddenham EG, Green AR. Postgraduate Haematology. 6th ed. London, UK: John Wiley & Sons; 2011.
16. Hoelzer D, Gökbuget N. Recent approaches in acute lymphoblastic leukemia in adults. Crit Rev Oncol Hematol 2000; 36: 49-58.
17. Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. New Engl J Med 2006; 354: 166-178.
18. Kollia P, Samara M, Stamatopoulos K, Belessi C, Stavroyianni N, Tsompanakou A, Athanasiadou A, Vamvakopoulos N, Laoutaris N, Anagnostopoulos A et al. Molecular evidence for transferrin receptor 2 expression in all FAB subtypes of acute myeloid leukemia. Leuk Res 2003; 27: 1101-1103.
19. Gupta S, Yeh S, Martiniuk A, Lam CG, Chen HY, Liu YL, Tsimicalis A, Arora RS, Ribeiro RC. The magnitude and predictors of abandonment of therapy in paediatric acute leukaemia in middle-income countries: a systematic review and meta-analysis. Eur J Cancer 2013; 49: 2555-2564.
20. Wang YR, Jin RM, Xu JW, Zhang ZQ. A report about treatment refusal and abandonment in children with acute lymphoblastic leukemia in China, 19972007. Leuk Res 2011; 35: 1628-1631.