Objectives Before 2003, most children with acute lymphoblastic leukaemia (ALL) abandoned treatment, with only approximately 30% treated in China. With the development of national insurance for underprivileged patients, we assessed the current frequency and causes of treatment abandonment among patients with ALL who were enrolled in the Chinese Children’s Cancer Group ALL protocol between 2015 and 2016.
Methods Demographic, clinical and laboratory data on patients who abandoned treatment, as well as economic and sociocultural data of their families were collected and analysed. General health-related statistics were retrieved from publicly accessible databanks maintained by the Chinese government.
Results At a median follow-up of 119 weeks, 83 (3.1%, 95% CI 2.5% to 3.8%) of the 2641 patients abandoned treatment. Factors independently associated with abandonment included standard/high-risk ALL (OR 2.62, 95% CI 1.43 to 4.77), presence of minimal residual disease at the end of remission induction (OR 3.57, 95% CI 1.90 to 6.74) and low-income economic region (OR 3.7, 95% CI 1.89 to 7.05). According to the family members, economic constraints (50.6%, p=0.0001) were the main reason for treatment abandonment, followed by the belief of incurability, severe side effects and concern over late complications.
Conclusions The rate of ALL treatment abandonment has been greatly reduced in China. Standard/high-risk ALL, residence in a low-income region and economic difficulties were associated with treatment abandonment.
Clinical trial registration number ChiCTR-IPR-14005706, pre-results.
- treatment abandonment
- paediatric acute lymphoblastic leukaemia
- economic difficulties
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C-HP and JT contributed equally.
Contributors JC, SS, JT and CHP had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. JC, SS, CC, CHP and JT designed the research study. JC, SS, RCR, CHP and JT wrote the paper. JC and CC analysed the data. Critical revision of the manuscript for important intellectual content was reviewed, edited and revised by all authors.
Funding Funding for this work was provided by the NCI grant CA21765, the National Natural Science Foundation of China (No 81670136, to JT) and the American Lebanese and Syrian Associated Charities (ALSAC).
Disclaimer The funding agencies had no role in the conduct, design, data collection, analysis and interpretation of the study, or in writing the report. The corresponding author had the final responsibility for submission of the manuscript for publication.
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Ethics approval The study was approved by the Institutional Review Board of each participating institution.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data sets used and/or analysed during the current study are available on reasonable request by writing to firstname.lastname@example.org.
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