Determinants of chemotherapy abandonment in Ethiopia: a nested case-control study

Breast cancer is one of the leading causes of cancer deaths in women worldwide. Systemic treatment can improve survival considerably. Breast cancer patients in many African countries face challenges during treatment and often abandon the recommended cycles of chemotherapy. Therefore, this study aims to describe the magnitude of abandonment and its determinants at 4 tertiary hospitals in Ethiopia.

An institution-based, nested case-control study was conducted. Initially, a cohort of patients with histologically diagnosed stage I-III breast cancer from 2019 to 2020 were reviewed. Then, a total of 400 patients (200 cases and 200 controls) were selected by simple random sampling from the medical log book. The data was collected from patients' charts and with a structured telephone interview-based questionnaire. The bivariate and multivariable logistic regression models were used to find the independent determinants.

Out of 1740 patients, 329 (18.9%) abandoned chemotherapy. The identified determinants for chemotherapy abandonment were stage III versus stage I/II adjusted odds ratio (AOR = 2.2, confidence interval (CI): 1.2-3.7), more financial constraints (AOR = 2.1, CI: 1.1-3.8), self-assertion of being healthy (AOR = 3.4, CI: 1.2-9.7), more expectations about side effects (AOR = 8.4, CI: 1.6-44.3), more intolerability of side effects (AOR = 2.0, CI: 1.2-3.5), initiating chemotherapy during COVID 19 (AOR = 3.0, CI: 1.7-5.2), and more fear of dependence on therapy (AOR = 7.8, CI: 4.4-13.9).

Nearly one-fifth of patients who started chemotherapy eventually abandoned their treatment. This means that patients experienced physical and financial toxicity as well as the efforts of health workers, but no treatment benefit. To avoid this, physicians need to closely follow the patients and explain the need to complete all chemotherapy cycles and treat side effects to avoid treatment abandonment with impaired survival. Additionally, attention must be paid to improving patient follow-up care during pandemics like COVID-19 and subsidizing therapy to ensure accessibility. Moreover, attention should be given to improving the subsidization of therapy and ensuring accessibility.