Socio-economic Status Plays Important Role in Childhood Cancer Treatment Outcome in Indonesia

Background: The influence of parental socio-economic status on childhood cancer treatment outcome inlow-income countries has not been sufficiently investigated. Our study examined this influence and exploredparental experiences during cancer treatment of their children in an Indonesian academic hospital. Materialsand
Methods: Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewedretrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structuredquestionnaires.
Results: Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poorpatients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versusprosperous patients. Parents often believed that their child’s health was beyond doctor control and determinedby luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God’s punishment (23%).Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more informationabout cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment(55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by theirchild’s cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%).
Conclusions: Treatment abandonment was most important reason for treatment failure. Treatment outcome wasdetermined by parental socio-economic status. Childhood cancer survival could improve if financial constraintsand provision of information and guidance are better addressed.