Factors influencing treatment decision-making for cancer patients in low- and middle-income countries: A scoping review.

PURPOSE: In this scoping review, we evaluated existing literature related to factors influencing treatment decision-making for patients diagnosed with cancer in low- and middle-income countries, noting factors that influence decisions to pursue treatment with curative versus non-curative intent. We identified an existing framework for adult cancer developed in a high-income country (HIC) context and described similar and novel factors relevant to low-and middle-income country settings. METHODS: We used scoping review methodology to identify and synthesize existing literature on factors influencing decision-making for pediatric and adult cancer in these settings. Articles were identified through an advanced Boolean search across six databases, inclusive of all article types from inception through July 2022. RESULTS: Seventy-nine articles were identified from 22 countries across six regions, primarily reporting the experiences of lower-middle and upper-middle-income countries. Included articles largely represented original research (54%), adult cancer populations (61%), and studied patients as the targeted population (51%). More than a quarter of articles focused exclusively on breast cancer (28%). Approximately 30% described factors that influenced decisions to choose between therapies with curative versus non-curative intent. Of 56 reported factors, 22 novel factors were identified. Socioeconomic status, reimbursement policies/cost of treatment, and treatment and supportive care were the most commonly described factors. CONCLUSIONS: This scoping review expanded upon previously described factors that influence cancer treatment decision-making in HICs, broadening knowledge to include perspectives of low- and middle-income countries. While global commonalities exist, certain variables influence treatment choices differently or uniquely in different settings. Treatment regimens should further be tailored to local environments with consideration of contextual factors and accessible resources that often impact decision-making.

Cost and Cost-Effectiveness of Treating Childhood Cancer at Jimma Medical Center.

Background: More than 70% of childhood cancer patients die in Sub-Saharan African countries due to a lack of access. Additionally establishing a childhood cancer treatment service is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of evidence on the actual cost and cost-effectiveness of this service in LMICs including Ethiopia. This study provides context-relevant evidence to consider childhood cancer treatment in the healthcare priority settings in Ethiopia and other LMICs. Methods: Newly admitted case files of children for the year 2020/21 were reviewed. The cost was analyzed from the provider's perspective. The effectiveness was calculated using DALY averted based on the 5 years of survival rates, which is estimated from the 1-year survival rate of Kaplan-Meier output. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate, and life expectancy. Results: During the study period, 101 children were treated in the unit. The total annual and unit cost to give treatment to childhood cancer patients was estimated at $279,648 and $2769, respectively. The highest per-patient annual unit cost of treatment was Hodgkin's lymphoma ($6252), while Retinoblastoma ($1520) was the least. The cost per DALY averted was $193, which is significantly less than Ethiopia's GDP per capita ($936.3). The results remained very cost-effective in sensitivity analyses. Conclusion: Childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in a conservative adjustment of assumptions. Therefore, to enhance and improve children's health, childhood cancer should get a better concern in health priority.

Caregiver satisfaction and its associated factors in pediatric wards of Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Measuring the caregivers' satisfaction is vital for the effectiveness of childcare. Children admitted to pediatric wards require special hospital situations, a bespoke approach from the medical team, and the participation of caregivers. It is important to give attention to the caregivers while planning for child services. The purpose of this study was to assess the caregiver's satisfaction with the services provided in pediatric wards of Jimma University Medical Center and identify its associated factors. METHODS: Facility-based cross-sectional study design was done at Jimma University Medical Center. Participants in the study were primary caregivers who spent two or more days in the pediatric ward with their admitted children. Data were collected from 400 selected caregivers. A consecutive sampling method was employed. Principal component analysis was done for all Likert scale instruments to extract factor (s) representing each of the scales and to have factor scores. Variables with the Likert scale were treated as continuous after principal component analysis was employed. Using these factor scores, a multiple linear regression analysis was carried out to identify factors associated with caregivers' satisfaction with service in pediatric wards. A significance level of less than 0.05 was used in the final model to determine statistical significance. RESULT: This study showed that caregivers' satisfaction with the services in the pediatric ward was 68%. Level of education (ß = -0.24, (95% CI; -.411, -.070)), availability of basic facilities (ß = 0.163, (95% CI; .063, .263)), patience to listen to patients' problem (ß = 0.431, (95% CI; .324, .537, staff communication with client (ß = 0.163, (95% CI; -4.839, -1.610)), availability of laboratory tests and its service (ß = -0.964, (95% CI; -1.435, -.493)), availability of drug, imaging and service at radiology (ß = 2.907, (95% CI; 1.470, 4.344)) and availability of pathology and its service (ß = 1.869, (95% CI; .993, 2.746)) were significant factors associated with caregivers satisfaction with health service in pediatrics ward. CONCLUSION: Caregivers were moderately satisfied. Education level, availability of basic facilities communication with client, and the availability of laboratory tests and drugs were factors that significantly associated with caregiver satisfaction. Hospital should avail laboratory tests and drugs in order to maintain high levels of caregiver satisfaction.

Clinical Presentation of Retinoblastoma in Ethiopia: A Case of Jimma University Medical Center Pediatric Oncology Unit, Southwest Ethiopia.

BACKGROUND: Retinoblastoma (RB) is one of the most curable childhood cancers if early detected and treated. Late presentation complicates the management of RB results in dismal treatment outcome. Objective: The aim of this study is to report the clinical presentation pattern of retinoblastoma patients seen at Jimma University Medical center (JUMC). METHODS: The study was a retrospective review of retinoblastoma cases managed at JUMC between August 2016 and July 2020. RESULTS: Among pediatric oncology cases registered retinoblastoma, accounting 8.5 % (36/423) of all childhood cancer patients in the study period, 29 (90.6%) of them had unilateral retinoblastoma and 3(9.4%) of them had bilateral retinoblastoma. The average age at presentation for bilateral and unilateral retinoblastoma patients was 17 (range 3-30) months and 37.5 months (range 8-84) respectively. The first symptom observed by the family was leukocoria in 21 (65.6%) of the patients but 24(75%) of the patients presented with advanced stage (proptosis and fungating orbital mass) of the disease. The longest and the shortest lag time of presentation from the first symptom was 17 months and 2 weeks respectively with the mean lag time of 1.4 months in bilateral and 6 months in unilateral cases. Clinically, the majority of the eyes 24/35(68.6%) were extraocular tumors involving orbital tissues at presentation. CONCLUSION: Most of retinoblastoma patients presented at advanced stage of the disease and presented very late after the family observed the disease. Early detection strategies must be designed by the government and responsible stakeholders in mitigating the effects of late presentation.