Work

Before Treatment Begins: A 5-Year Analysis of Upfront Cancer Care Abandonment in India.

Year: 2026

Type: article

Abstract: Introduction: Upfront treatment abandonment, defined as failure to initiate planned definitive therapy after diagnosis, is one of the leading causes of poor outcomes in childhood cancer in low and middle income countries.This analysis was done to evaluate the frequency of treatment abandonment across different cancers and evaluate factors contributing to abandonment.Methods: We retrospectively reviewed records of newly diagnosed pediatric oncology patients registered between January 2021 and December 2025 at our center.Upfront treatment abandonment was defined as noninitiation of planned cancer-directed therapy.Disease-wise abandonment rates were analyzed, and documented reasons for abandonment were reviewed from case files.Results: Among 2,229 children diagnosed with cancer, 211 abandoned treatment before initiation, yielding an overall upfront treatment abandonment rate of 9.47%.While acute lymphoblastic leukemia was the most frequent diagnosis-making up 40% of all cases with a 9.6% abandonment rate.Over a third of patients with osteosarcoma (36.4%) and nearly a quarter with acute myeloid leukemia (24.2%) never began therapy.Other significant abandonment rates included rhabdomyosarcoma (16.2%),Ewing sarcoma (13.8%), neuroblastoma (11.3%), and Wilms tumor (11%).Among families with documented reasons for leaving, real world burdens of financial hardship (62%), preference for alternative medicine (23%), lack of family support (20%), and social stigma (15%) were the predominant contributing factors.Conclusion: Despite modern treatments, nearly 10% of children in this study never began care.As this study shows, the risk of a family walking away heavily depends on the specific diagnosis.Importantly, simply offering financial aid is not enough.Families are still being driven away by the hidden costs of care, the draw of alternative medicine, and the heavy social stigma of a cancer diagnosis.To close this gap, oncology programs must implement intensive, immediate social work and counseling interventions from the exact moment of diagnosis.

Source: Pediatric Hematology Oncology Journal

DOI: 10.1016/j.phoj.2026.100999