Baseline Risk of Treatment Abandonment and Survival of Children With Common and Curable Cancers in the Zero Abandonment Cash Transfer Programme—A Multi-Centre Prospective CANCaRe Africa Study

Abstract

Background: The WHO Global Initiative for Childhood Cancer (GICC) targets a global survival rate of 60% for childhood cancer, focusing initially on six common and curable cancers. This study assessed the risk of treatment abandonment (TxA) and the impact on survival of five of these cancers in sub-Saharan Africa in preparation for a cash transfer intervention. Methods: This multi-centre, prospective, observational cohort study included newly diagnosed children ( < 16 years) with Burkitt lymphoma (BL), acute lymphoblastic leukaemia (ALL), Wilms tumour (WT), retinoblastoma (RB) or Hodgkin disease (HD), enrolled between January 2022 and April 2024 from hospitals in Ethiopia ( n = 2) and Uganda. Event-free survival (EFS) was estimated using Kaplan–Meier methods, and the cumulative incidence of TxA was estimated using competing risks methods. Results: Of 370 patients enrolled (median age 6 years, 62% boys), ALL was the most common diagnosis (30%, 112/370). Median follow-up was 26 months (range 6–35 months). The overall risk of treatment abandonment was 43%, ranging from 20% in Mbarara, Uganda to 54% in Gondar, Ethiopia. It was highest in patients with WT (48%) and RB (49%). Overall, 2-year EFS was 28% (confidence interval [CI] 24%–34%) with TxA as an event and 59% (53%–66%) when TxA cases were censored. Conclusion: The overall risk of treatment abandonment is high, 43%, in this baseline ‘Zero Abandonment’ study in participating hospitals in Ethiopia and Uganda. Treatment abandonment significantly affects survival, currently 28%, and potentially to increase to 59% if treatment abandonment was completely prevented.