Treatment abandonment in children with Wilms tumor at a national referral hospital in Uganda

• Published in: Pediatric surgery international Vol. 40; no. 1; p. 162
• Main Authors: Nanteza, Sumayiya, Yap, Ava, Stephens, Caroline Q., Kambagu, Joyce Balagadde, Kisa, Phyllis, Kakembo, Nasser, Fadil, Geriga, Nimanya, Stella A., Okello, Innocent, Naluyimbazi, Rovine, Mbwali, Fiona, Kayima, Peter, Ssewanyana, Yasin, Grabski, David, Naik-Mathuria, Bindi, Langer, Monica, Ozgediz, Doruk, Sekabira, John
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 27-06-2024; Springer Nature B.V
• Subjects: Cancer therapies; Chemotherapy; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Kidney Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Neoadjuvant Therapy - statistics & numerical data; Original; Original Article; Pediatric Surgery; Pediatrics; Referral and Consultation - statistics & numerical data; Retrospective Studies; Surgery; Treatment Refusal - statistics & numerical data; Uganda; Wilms Tumor - surgery; Wilms Tumor - therapy; Uganda; Pediatric oncology; Pediatric surgery; Treatment abandonment; Low–middle income country; Wilms tumor; Global surgery
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-024-05744-7

Introduction
The incidence of pediatric Wilms’ tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda.
Methods
A cohort study of patients < 18 years with WT in a Ugandan national referral hospital examined clinical and treatment outcomes data, comparing children whose families adhered to and abandoned treatment. Abandonment was defined as the inability to complete neoadjuvant chemotherapy and surgery for patients with unilateral WT and definitive chemotherapy for patients with bilateral WT. Patient factors were assessed via bivariate logistic regression.
Results
137 WT patients were included from 2012 to 2017. The mean age was 3.9 years, 71% (
n
 = 98) were stage III or higher. After diagnosis, 86% (
n
 = 118) started neoadjuvant chemotherapy, 59% (
n
 = 82) completed neoadjuvant therapy, and 55% (
n
 = 75) adhered to treatment through surgery. Treatment abandonment was associated with poor chemotherapy response (odds ratio [OR] 4.70, 95% confidence interval [CI] 1.30–17.0) and tumor size > 25 cm (OR 2.67, 95% CI 1.05–6.81).
Conclusions
Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.