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

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.

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).

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.

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.

National Institutes of Health, K12CA090433.