Interventions to Reduce Pediatric Cancer Treatment Abandonment in Low- and Middle-Income Countries: A Scoping Review

Abstract

Background: Pediatric cancer treatment outcomes in low- and middle-income countries (LMICs) significantly lag behind those in high-income countries. One reason for this disparity is high treatment abandonment rates, defined as a failure to start or complete curative-intent therapy after a cancer diagnosis. We conducted a scoping review to describe interventions aimed at reducing treatment abandonment in pediatric cancer patients in LMICs.

Methods: Studies identified through systematic database search were included if they met the following criteria: (a) studied an intervention on treatment abandonment; (b) included cancer patients ≤18 years of age; (c) conducted in LMICs as defined by the World Bank income classification; (d) contained pre- and post-intervention measures of treatment abandonment. We restricted inclusion to English-language publications. Two reviewers independently screened the eligible publications and extracted the data. Interventions were categorized as focusing on socioeconomic support, education/psychosocial support, or clinical care quality and capacity improvements (e.g., care navigation, coordination, or therapeutic/diagnostic expansion).

Findings: Among the 1,808 articles identified in the search, 21 studies met inclusion criteria: four from the WHO African region, nine from the Americas, seven from the South-East Asian, and three from the Western Pacific Region. Sixteen studies (66%) focused on one category for improvement, and eight (34%) were a mixture of two or more categories. All studies demonstrated a decrease in treatment abandonment after the intervention. The median absolute risk reduction (ARR) was 16% (interquartile range [IQR] 10%-24%). The median relative risk reduction was 72% (IQR 60%-82%). The median pre-intervention abandonment rate across full-text studies was 27% (IQR 20%-34%) and decreased to 7% (IQR 3%-12%) after intervention. Interventions with the largest ARR values included components of socioeconomic support, psychosocial support, and clinic care improvements. All of the 10 studies reporting pre- and post-intervention survival outcomes reported increases in survival following the intervention.

Interpretation: Our scoping review describes interventions that were associated with reduced pediatric cancer treatment abandonment in LMICs. Interventions that combined socioeconomic support, psychosocial support, and clinical care quality/capacity improvements yielded the largest reductions. Despite these encouraging findings, limitations of the evidence, including short study durations, single-center designs, lack of control groups, and likely publication bias, restrict the generalizability of results. These findings suggest that treatment abandonment is a targetable and potentially modifiable challenge in LMICs, and that survival outcomes can improve when health systems adopt multifaceted interventions that support families and strengthen care delivery.

Funding: National Institutes of Health, K12CA090433.