Challenges in the Pharmacological Management of Non Hodgkin’s Lymphoma in Children in the Maintenance Phase of Therapy at Kenyatta National Hospital

Abstract

Background: Non Hodgkin’s lymphoma is an extremely chemo sensitive with a five year event free survival of greater than 90% in developed countries and a one year survival rate of 40-50% in developing countries. There have been no documented studies done at Kenyatta National Hospital on the various challenges faced by patients and their guardians that may hinder its optimal management. Objectives: To investigate the major challenges faced in the management of Non Hodgkin’s lymphoma in pediatric patients in the maintenance phase. Methodology: This was a hospital based cross-sectional study, among 19 Paediatric outpatients with Non Hodgkin’s Lymphoma and in the maintenance phase of therapy at Kenyatta National Hospital. Data was collected using structured questionnaires and from patient files and was analyzed using Statistical Package for Social Sciences version 17.0. P values ≤ 0.05 were considered significant. Fischer’s exact test was used to test for association between adherence and various categorical variables such as patient factors, guardian factors and hospital and service delivery setup. Results: Of the 19 patients, 13 (68.4%) were found to be male. The mean age for all the patients was 9.84 years (95% CI: 8.3, 11.3). 42.1% of the patients had missed their oral medication. The method of acquisition of oral medication, estimated expenditure on medication per month and whether the guardian was counseled on the side effects of the medication, were found to be statistically significant (p value 0.037, 0.02 and 0.037 respectively). The most prevalent (94.7%) side effects were loss of hair followed by change in nail/skin pigmentation (73.7%) with the least observed side effects being dizziness, constipation and tingling sensation of lower extremities. Cumulative doses of doxorubicin used showed that majority of the patients (63.1%) had cumulative doses between 200-400mg/m2 while only 10% had cumulative doses above 400mg/m2. Conclusion: The overall adherence to oral chemotherapy was found to be 57.9%. Method of acquisition of the oral medication, estimated expenditure on medication per month and counseling on medication and its side effects were significant barriers to adherence. Based on cumulative doses of doxorubicin used, 63.1% of the patients in this study stand a low risk of developing cardio toxicity with only 10% standing a significant risk of cardio toxicity.