The Impact of a Hostel on Outcomes for Pediatric Cancer Patients in Northern Tanzania

Background: There is a significant disparity in survival rates for pediatric cancer in low and middle-income countries compared to high-income countries. A variety of factors contribute to this disparity including late stage disease at presentation, high rates of abandonment of care, and lack of supportive care. In Mwanza, Tanzania, a residential hostel was created to reduce these barriers among patients being treated for childhood cancer at Bugando Medical Centre (BMC). This study explores the potential benefit of the hostel in terms of event free survival and quality of life and examines the barriers and facilitators for completing care and the perceptions of the hostel. Methods: The study had three major components. A medical record review was conducted for 229 patients who presented to BMC in 2016-17, looking at survival outcomes. Surveys were collected from patients and caregivers who presented in 2018. In-depth interviews were conducted to explore patient/caregiver experiences. Data was collected at BMC and was analyzed with survival curves, hazard models, logistic regression, t-tests and applied thematic analysis. Results: One-year EFS was not significantly different for patients who presented to BMC before the hostel opened compared to those that presented after the hostel opened. However, a proportional hazard model showed a significantly lower hazard for patients that stayed at the hostel compared to patients that did not. Participants that stayed at the hostel also scored significantly higher in emotional functioning compared to patients that did not stay at the hostel. In-depth interview participants highlighted barriers and facilitators for completing care and described the benefits of the hostel including psychosocial support and reduced financial burden. Conclusions: Higher one-year event free survival and better scores in emotional wellbeing were observed for patients that stayed at the hostel. Caregivers and patients shared positive perceptions of the hostel as a facilitator for completing care. Key supportive care programs such as a hostel can be beneficial for improving pediatric cancer outcomes in LMICs.