Impact of sociodemographic factors and nutrition on the duration of induction phase of chemotherapy in children with acute lymphoblastic leukemia: A tertiary center experience from North India

Abstract

Background: Immunocompromised patients are at increased risk of infections, especially those living in poor hygienic conditions. Aims and Objectives: This study aims to assess the effect of weight, immunization status of the child at the start of treatment along with the socioeconomic status (SES), and demographic parameters, i.e., type of house, sanitary facility (SF), and source of drinking water on the duration of induction phase of chemotherapy (delayed if the patient received chemotherapy for >29 days). Materials and Methods: 110 pediatric acute lymphoblastic leukemia patients aged 1.5-14 years who underwent induction of remission from June 2015 to February 2018 were included. The immunization status and weight of the child were recorded at the start of treatment. SES was assessed using modified Kuppuswami scale and a questionnaire was used to determine various sociodemographic parameters. Results: The patients not immunized as per age (P = 0.000) and having poor demographic parameters, i.e., mud house (P = 0.000), absence of SF (P = 0.013), and nonfiltered drinking water (P = 0.005), had significant delay. The duration of induction phase of chemotherapy was not delayed with poor SES (P = 0.832). Although the duration was delayed in patients with weight ≥10 percentile, it was not statistically significant (P = 0.079). On analyzing the three demographic parameters together as Water-Sanitary Facility-Housing (WaSH) Score (0-4), the duration was also significantly delayed if the patients had WaSH score <2. Conclusion: The duration of induction phase of chemotherapy is delayed with inadequate immunization status and poor hygiene of the child.