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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(01): 32-37
DOI: 10.4103/0971-5851.177013
ORIGINAL ARTICLE

Trends in management of acute lymphoblastic leukemia: Influence of insurance based healthcare and treatment compliance on the outcome of adolescents and adults with acute lymphoblastic leukemia

Ravi Arigela
Department of Medical Oncology, Nizam′s Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sadashivudu Gundeti
Department of Medical Oncology, Nizam′s Institute of Medical Sciences, Hyderabad, Telangana, India
,
Ranga Ganta
Department of Medical Oncology, Nizam′s Institute of Medical Sciences, Hyderabad, Telangana, India
,
Srividhya Nasaka
Department of Medical Oncology, Nizam′s Institute of Medical Sciences, Hyderabad, Telangana, India
,
Vijay Linga
Department of Pathology, Centre for Cancer Research, UTHSC, Memphis, TN, India
,
Lakshmi Maddali
Department of Medical Oncology, Nizam′s Institute of Medical Sciences, Hyderabad, Telangana, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aim: In this study, we attempted to analyze the impact of insurance based health care system and treatment compliance on the outcome of adolescent and adults with acute lymphoblastic leukemia (ALL). Materials and Methods: Patients who underwent treatment for ALL during the period 2003-2011 were enrolled into this retrospective study. Patients on supportive or palliative care only and patients with age <10 years were excluded. The hospital records and tumor registry records were studied. Patients were stratified into two groups, Group A (prior to the introduction of state health insurance [SHI], 2003-2007) and Group B (after the introduction of SHI, 2008-2011). Overall survival (OS) was calculated using Kaplan-Meier method. Results: A total of 420 patients with suspected or confirmed ALL visited our center during the study period and 179 patients (87 in Group A and 92 in Group B) were considered for inclusion. The median age in years (range) was 18 (10-57) and 18 (10-58) respectively in Groups A and B with males more than females. Median OS (95% CI) was 9 (6.7-11.2) and 12 (7.3-16.7) months in the Groups A and B respectively (P = 0.265). Poor treatment compliance in both groups was high (36% in Group A and 41% in Group B, [P = 0.107]) with lower default rates in Group B (P = 0.019). Patients with good compliance in the total study population and the individual study groups had significantly better OS. Conclusions: Insurance based health care has improved outcomes in the present study but not compliance to treatment. Significantly better OS was observed in patients with good compliance.

Keywords

Acute lymphoblastic leukemia - adult - compliance - health care - insurance


Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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