Treatment Refusal Among Pediatric Oncology Patients from a Tertiary Care Center in South India

Abstract Treatment refusal and abandonment are among the leading causes for treatment failure in childhood malignancies in many developing countries. The parental perspective has been the subject of a relatively small number of studies. In this study, we analyzed the variables that were related to treatment refusal among parents of children who were diagnosed with cancer at our facility during the study period. This article determines reasons for refusal of treatment in our cohort of pediatric cancer patients. This cross-sectional, comparative observational study was conducted over a 12-month period. All parents and caregivers of children under 15 years, newly diagnosed with cancer, were included. A predesigned pro forma was used to record the information. Parental reasons for refusing therapy were gathered through an interview based on validated semistructured questionnaires. The patients who declined definitive care were compared to those who consented to therapy. Of the 495 patients, 56 (11.3%) refused treatment. The factors like hailing from rural area, belonging to lower socioeconomic strata, and not having an insurance cover were associated with treatment refusal (p ≤ 0.01). Acute myeloid leukemia had the highest proportion of treatment refusals (11/40, 24%). Family-related problems were the primary factor cited by 38% of caregivers. Other reasons included duration of treatment (21%), advanced stage (18%), distance of the hospital (9%), and financial constraints (11%). Though outcomes for pediatric cancers have improved, treatment refusal remains a challenge in our country. The socioeconomic and demographic characteristics are significant factors contributing to this. Early identification and addressing these factors by various strategies, like improving awareness and financial support, could increase compliance.