Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children's Cancer Group
Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children's Cancer Group
复制标题
中国儿童急性淋巴细胞白血病的治疗放弃：中国儿童癌症研究组的回顾性队列研究
DOI：
10.1136/archdischild-2018-316181
复制
发表时间：
2019-06-01
影响因子：
5.2
通讯作者：
Tang, Jingyan
中科院分区：
文献类型：
--
作者：
Cai, Jiaoyang;Yu, Jie;Tang, Jingyan
2003年以前，大多数急性淋巴细胞白血病（ALL）患儿放弃治疗，在中国只有大约30%的患儿接受治疗。随着贫困患者国民保险的发展，我们评估了2015年至2016年参加中国儿童癌症组ALL方案的ALL患者目前放弃治疗的频率和原因。方法收集和分析放弃治疗患者的人口学、临床、实验室资料及其家庭经济、社会文化资料。一般健康相关统计数据从中国政府维护的可公开访问的数据库中检索。在中位随访119周时，2641例患者中有83例（3.1%,95% CI 2.5%至3.8%）放弃治疗。与放弃相关的独立因素包括标准/高风险ALL （OR 2.62, 95% CI 1.43至4.77）、缓解诱导结束时存在最小残留疾病（OR 3.57, 95% CI 1.90至6.74）和低收入经济地区（OR 3.7, 95% CI 1.89至7.05）。家庭成员表示，经济困难（50.6%,p=0.0001）是放弃治疗的主要原因，其次是认为无法治愈、副作用严重和担心晚期并发症。结论中国急性淋巴细胞白血病的放弃率已大大降低。标准/高风险ALL、居住在低收入地区和经济困难与放弃治疗有关。
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.