• Completion of cancer treatment depends on paying for the costs of treatment through personal finances or health insurance.
• Overall survival and event-free survival were higher for insured versus uninsured children.
One thing appears to determine whether children with cancer survive or die: health insurance.
Records of 763 children treated for cancer at the Moi Teaching and Referral Hospital in Eldoret between 2010 and 2016 show stark differences in the outcomes of those with insurance and those without.
Of the children, 280 had National Health Insurance Fund coverage at diagnosis and 299 enrolled during treatment, leading to a total 579 with NHIF.
“The most likely treatment outcome in uninsured patients was death (49 per cent), whereas in those with health insurance at diagnosis and those who enrolled during treatment, it was event-free survival (36 per cent and 41 per cent, respectively),” researchers reported.
"Overall survival and event-free survival was higher for insured versus uninsured patients."
They said the most common cause of treatment failure was abandonment of treatment followed by death.
“In our centre, the most common reasons for treatment abandonment were financial difficulties and inadequate access to NHIF,” the researchers said.
Their study, 'Influence of health‑insurance on treatment outcomes of childhood cancer in Western Kenya,' was published in the 'Supportive Care in Cancer Journal' on July 15.
The patients ages at diagnosis ranged between 0 and 16 years with a mean age of 6.5 years.
They said cancer treatment completion is dependent on the ability to cater for the costs of treatment through personal finances or health insurance.
Those who can afford insurance are increasingly getting a better chance to live.
The study shows treatment outcomes have improved significantly because event-free survival is 32 per cent in Western Kenya, compared to half of that in 2007.
Event-free survival refers to how long a person survives after treatment without experiencing complications, such as cancer coming back or worsening.
“Overall survival and event-free survival were higher for insured versus uninsured patients,” the researchers said.
The improved survival was attributed to the adoption of standardised treatment protocols, less treatment abandonment, better multidisciplinary care and more knowledgeable health personnel.
The MTRH study shows uninsured children do not benefit from these advances.
They have no access to healthcare and remain undiagnosed for a long time. Those without insurance go to cheap facilities where they are either misdiagnosed or receive delayed diagnosis. Thus, they present with advanced stages of disease, lowering the probability of cure.
The study's findings highlight the importance of universal health coverage for children with cancer. Universal health coverage would ensure that all children have access to the cancer treatment they need, regardless of their family's financial situation.
This would help to improve survival rates for children with cancer and reduce the burden on families, the authors said.
The researchers urged healthcare providers to actively help families with health insurance registration.
Early this year, the World Health Organization called on countries including Kenya to invest in early detection and effective therapy and medicines for treatment of childhood cancers.
WHO raised concern that nationally, only 20 per cent of children with cancer in Kenya survive compared to more than 80 per cent in developed countries.
“The likelihood of surviving a diagnosis of childhood cancer depends on the country where the child lives,” WHO said.
The global health agency listed delay in diagnosis, inability to obtain an accurate diagnosis and inaccessible therapy as some reasons for lower survival rates.
Others include abandonment of treatment, death from toxicity (side effects) and avoidable relapse.
“Improving access to childhood cancer care, including to essential medicines and technologies, is highly cost-effective, feasible and can improve survival in all settings,” WHO said.
A recent report by the National Cancer Institute showed that leukaemia accounts for the highest childhood cancer burden in Kenya followed by brain tumours and lymphoma.
Data also shows that seven in every 10 childhood cancer cases are at advanced stages, with the age group with the highest incidences of childhood cancers being zero to 14 years.
Childhood cancers are curable if diagnosis and detection are done early and early treatment is initiated.