Factors associated with default of treatment and follow-up among cancer patients.

Abstract

e18528 Background: Default during treatment or follow-up is a major area of concern in oncology. Default leads to disease progression, treatment failure, and drug resistance ultimately resulting in increased morbidities and mortality. Default also serves as a mode of confusion and burden to the treating physician who has to re-tailor the treatment. We carried out this study to look for the characteristics and reasons associated with the default during among patients with cancer. Methods: Patients registered with a histologically confirmed diagnosis of solid organ cancer and default during evaluation, treatment, and follow-up were included. Default was defined as skipping a scheduled visit during evaluation by a duration of more than 2 weeks, skipping a scheduled session of chemotherapy by a period of more than the duration between chemo-sessions (week or 2-weeks or 3-weeks), or lost to follow -up (skipped 2 or more scheduled consecutive visits with no further intention of continuing treatment). Information regarding performance status, stage, phase of the treatment, reason for default, educational status of the patient, and demographic profile were noted. Lost to follow-up patients were interviewed telephonically. Results: One hundred seven patients with default were interviewed. Sixty-five percent were males. Thirty-six percent of the patient were of geriatric age-group. Eighty-four percent patients had an ECOG-PS of 0,1 or 2 immediately prior to default. Thirty-three percent of the patient had an early-staged disease. Fifty-four percent of the patients were illiterate. The intent of the treatment was curative in 36 % of the patient. Close to 92% of the patients defaulted during the treatment phase while the rest during evaluation or follow-up. The most common reasons for default were lack of social support (32%), financial distress (22%), difficulty in finding transport (16%), and too sick to come (15%). The lack of social support was evident due to the fear of the loss of daily wages by the family members. The average distance traveled by each patient from home to the cancer center was 131.5 kilometers. Other reasons included poor follow-up counseling by the healthcare staff, demise at home, shifting to alternative treatment (fear of chemo-toxicities), concomitant illness, religious reasons, and general well-being. Thirty-one percent of the patients reported more than one reason for non-compliance. Conclusions: The study reveals illiteracy, lack of social support, and financial distress as major causes of default. Although more than 90% of the patients are covered under PMJAY scheme, which provides free-of-cost treatment, the cost of transportation and the time consumed in commuting to a far-off center adds to the misery. These issues need to be addressed at national levels. Appropriate counselling regarding insight of the disease and adherence to the treatment is desired at the healthcare provider level.