Cancer Center Support Grant

Washington University, Saint Louis MO

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY/ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT-CA- 23-052: Economicsof Cancer Control in LMICs.” Childhood cancer survival rates are less than 20% in low- and-middle-income countries (LMICs) compared to 80% in high income countries. A LMICs move outcomes stays, distance, driving diagnosis living drive identify Zambia out who cash ensure outcomes Zambian treatment delivery carry administrators and developed will emphasizing research in substantial challenge in like Zambia is that l imited treatment locations in urban centers necessitate that hildren and caregivers from more distant or rural places. Because of this, childhood cancer i s frequently diagnosed late when are poor. Adding t o this, rural and distant patients and families in LMICs can have longer hospital incur more expenses, nd are at greater risk of abandoning treatment. In effect, cost-driving factors (e.g., time, and treatment costs) further intersect with multiple social identities (e.g., poverty, rural i dentity), further inequities in outcomes. Thus, elucidating and intervening in costs that delay and disrupt and treatmen will be critical to improving access to diagnosis and t reatment for children with cancer in distant, remote, and/or rural locales. Cash transfer interventions may address the multiple costs that childhood cancer diagnostic and treatment delays, and treatment abandonment. Thus, our objective is to modes of delivering cash transfers t o rural and remote childhood cancer patients and families in LMICs. is an ideal setting to carry out cash transfer interventions t o improve childhood cancer outcomes. Nine of every 10 children in Zambia with cancer do not reach either diagnosis or treatment, and 90% of those do, abandon treatment or die before treatment ompletion Zambia also has one of the longest running transfer programs in the region, but has no yet been used for treatable health conditions like cancer. To the appropriateness and sustainability of cash transfers o reduce costs and improve treatment for rura l and remote children with cancer, we propose two aims with strong support from the Ministry of Health. Aim 1: To identify the multiple costs associated with cancer diagnostic and delay and abandonment for children from distant locales. Aim 2: Determine mechanisms for the and sustainability of cash transfers for childhood cancer care at the healthcare system level. We will out document review, participatory workshops, and meetings with legislative members and health system to adapt cash transfers to the health system. Upon completion, we will have identified t he formal informal costs that drive childhood cancer diagnostic and treatment delay and abandonment and a pathway for introducing a treatment f ocused cash transfer intervention for childhood cancer. We use these findings to propose an R01 to carry out a hybrid type 2 trial of this cash transfer intervention, cost and sustainability as implementation outcomes. Successful completion wil l also foster the careers of promising j unior members of our LMIC research team, a necessary step to build capacity Zambia and in global cancer equity researcher and leadership. c a t c . t t