Addressing Treatment Abandonment in Pediatric Oncology: The Role of Missed Appointment Call-Back Systems in a Pakistani Setting

Objective: To evaluate the effectiveness of a missed appointment call-back system in reducing treatment abandonment rates at a tertiary care hospital in Pakistan. Methods: This cross-sectional study was conducted in the Pediatric Hematology and Oncology Department of Indus Hospital and Health Network from April to September 2023. The study included children aged 1 month to 16 years diagnosed with cancer and receiving curative treatment. A call-back system was introduced, contacting patients within 48 hours of a missed appointment to address their absence and reschedule. Treatment abandonment was defined as missing clinic visits for 4 weeks. Results: Of 389 children, the mean age was 6.8 ±4.0 years. There were 258 (66.3%) males and 131 (33.6%) females. Treatment abandonment was observed in 26 (6.7%) patients. The likelihood of treatment abandonment was 6 times significantly higher in children who did not respond to the call than those who did respond (cOR 6.27, 95% CI 2.69 to 14.59, p-value <0.001). Similarly, children who missed rescheduled appointments had 8 times higher chances of treatment abandonment than those who attended (cOR 8.11, 95% CI 3.30 to 19.92, p-value <0.001). Among 26 treatment abandonment children, the most common reason of missed appointment was financial issue 10 (38.5%) followed by forget appointment 7 (26.9%), attending school 6 (23.1%), and long distance 3 (11.5%). Conclusion: Treatment abandonment was low as 6.7%. Children who did not respond to call-backs or missed rescheduled appointments were significantly more likely to abandon treatment. The call-back system is effective in reducing abandonment rates in pediatric oncology.