Prospective Cohort Study Testing Interventions to Reduce Diagnosis Delay and Treatment Abandonment of Children With Burkitt Lymphoma in Kenya

Abstract

PURPOSE Low survival rates among children with Burkitt lymphoma (BL) in low- and middle-income countries (LMICs) are caused by multiple factors, including delays in diagnosis and treatment abandonment. These issues are often linked to the cost of diagnostic tests, treatment, and transportation. This study de- scribes the implementation and effectiveness of a program targeting these issues among children with BL in Kenya. METHODS Children with symptoms suggestive of BL between 2017 and 2018 were pro- spectively enrolled in an intervention program including (1) Diagnosis Delay Intervention by performing flow cytometry and covering its cost and (2) Treatment Abandonment Intervention by reimbursing transportation costs, compensating for some lost family income because of the child’s hospital stay, and sending reminder phone calls. A medical record review was conducted to perform a historical comparison of diagnosis delay and treatment outcomes between two cohorts (2010-2016 v 2017-2018) to measure the effectiveness of the program. RESULTS Forty-three patients who had a pathologically confirmed diagnosis of BL were enrolled in the intervention program. When comparing the historical cohort (2010-2016; N 5 138) and the prospective cohort (2017-2018; N 5 43), it was found that after implementing the program, the mean time to diagnosis de- creased from 13.57 days to 10.58 days (P 5 .026). Treatment abandonment decreased from 27% to 5% (P < .001), and the event-free survival estimates also showed a significant improvement, increasing from 33% to 63% between the historical and prospective cohorts (P 5 .027). CONCLUSION The combination of timely diagnosis and modest financial support for families to complete treatment significantly improved the survival rate of children with BL in our study. This program has the potential to be implemented for children with other cancers and in other LMIC settings