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Original article
Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children’s Cancer Group
  1. Jiaoyang Cai1,
  2. Jie Yu2,
  3. Xiaofan Zhu3,
  4. Shaoyan Hu4,
  5. Yiping Zhu5,
  6. Hua Jiang6,
  7. Chunfu Li7,
  8. Yongjun Fang8,
  9. Changda Liang9,
  10. Xiuli Ju10,
  11. Xin Tian11,
  12. Xiaowen Zhai12,
  13. Jinjin Hao13,
  14. Qun Hu14,
  15. Ningling Wang15,
  16. Hui Jiang16,
  17. Lirong Sun17,
  18. Chi Kong Li18,
  19. Kaili Pan19,
  20. Minghua Yang20,
  21. Shuhong Shen1,
  22. Cheng Cheng21,
  23. Raul C Ribeiro22,
  24. Ching-Hon Pui22,
  25. Jingyan Tang1
  26. Chinese Children’s Cancer Group childhood acute lymphoblastic leukaemia (ALL) 2015 study group (CCCG-ALL-2015)
  1. 1 Department of Hematology/Oncology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, and National Children’s Medical Center, Shanghai, China
  2. 2 Department of Hematology/Oncology, Chongqing Medical University Affiliated Children’s Hospital, Chongqing, China
  3. 3 Department of Pediatrics, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
  4. 4 Department of Hematology/Oncology, Children’s Hospital of Soochow University, Suzhou, China
  5. 5 Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
  6. 6 Department of Hematology/Oncology, Guangzhou Women and Children’s Health Care Center, Guangzhou, China
  7. 7 Department of Pediatrics, Southern Medical University Affiliated Nanfang Hospital, Guangzhou, China
  8. 8 Department of Hematology/Oncology, Nanjing Children’s Hospital Affiliated to Nanjing Medical University, Nanjing, China
  9. 9 Department of Hematology/Oncology, Jiangxi Provincial Children’s Hospital, Nanchang, China
  10. 10 Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
  11. 11 Department of Hematology/Oncology, Kunming Children’s Hospital, Kunming, China
  12. 12 Department of Hematology/Oncology, Children’s Hospital of Fudan University, Shanghai, China
  13. 13 Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Union Hospital, Wuhan, China
  14. 14 Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
  15. 15 Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Hefei, China
  16. 16 Department of Hematology/Oncology, Children’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
  17. 17 Department of Pediatrics, Qingdao University Affiliated Hospital, Qingdao, China
  18. 18 Deparment of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
  19. 19 Department of Hematology/Oncology, Northwest Women’s and Children’s Hospital, Xi’an, China
  20. 20 Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan, China
  21. 21 Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
  22. 22 Department of Oncology, St Jude Children’s Research Hospital, Memphis, USA
  1. Correspondence to Dr Ching-Hon Pui, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA; Ching-Hon.Pui{at}STJUDE.ORG and Dr Jingyan Tang, Department of Hematology/Oncology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology and Oncology of China Ministry of Health, Shanghai 200127, China; tangjingyan{at}scmc.com.cn

Abstract

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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Footnotes

  • 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 caijiaoyang@scmc.com.cn.

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