Caregiver-Reported Reasons and Outcomes of Treatment Default among Pediatric Oncology Patients at a Tertiary Care Hospital in Pakistan

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Despite the availability of free care, many children in Pakistan fail to complete cancer therapy, leading to poor outcomes and increased mortality. Objective: To determine reasons and outcomes of pediatric cancer patients defaulting treatment at tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted at Pediatric Hematology/Oncology unit of Children Hospital, Lahore. Total 82 pediatric oncology patients (<16 years) who started treatment but defaulted at any stage between 1st January and 30th June 2024 were included. Caregivers were interviewed regarding default reasons, and relevant clinical data were analyzed using SPSS version 27.0 for descriptive statistics. Results: Most frequently reported contributing factors were financial issues (100%), out-of-pocket expenses (98.8%), long travel distance (92.7%), and poor socioeconomic status (91.5%). Family-related challenges included other responsibilities (89%), parental job issues (84.1%), poor understanding of disease (81.7%), and lack of family support (63.4%). Additional reasons included large family size (72%) and family pressure to abandon treatment (29.3%). Patient-related causes were faith-based healing (50%), perceived long treatment duration (31.7%), consent withdrawal (25.6%), and fear of surgery (18.3%). System-related barriers included treatment unavailability (11%) and dissatisfaction with care (7.3%). Upon return, 54.3% were eligible only for palliative care, 25.6% resumed curative treatment, 14.8% expired, 3.7% were cured, and 2.5% were lost to follow-up. Conclusion: Treatment default in pediatric oncology is driven by financial, social, and systemic challenges. Overcoming these obstacles is essential to enhance treatment adherence and improve patient outcomes.

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