Protocol Compliance and the Use of mHealth to Reduce Pediatric Cancer Treatment Abandonment in Tanzania

Abstract

Background: Low treatment compliance is a well-established barrier to survival for pediatric cancer patients, including those with Burkitt Lymphoma (BL). At Bugando Medical Center in Mwanza, Tanzania, an mHealth application, mNavigator, is being used to improve protocol compliance through algorithm-directed BL treatment. With the implementation of mNavigator and the rise of mHealth initiatives globally, there is a need to build evidence for the use of mHealth in improving protocol compliance, to encourage the use of mHealth in the pediatric BL context. Methods: A 21-section checklist was created based on the Tanzanian National Guidelines for BL treatment to systematically calculate protocol compliance. All patients <18 years of age diagnosed with BL at Bugando Medical Center in Mwanza, Tanzania from March 2016 to Feb 2021 were included in the evaluation. The patients were separated into a historic and prospective (intervention) cohort based on the introduction of mNavigator, in August 2019. The compliance scores were calculated and analyzed for each cohort using StataSE 16. Results and discussion: A total of 82 patients were analyzed in this study, 49 in the historic cohort and 33 in the intervention cohort. There was a significant 9.2% (p = 0.02) increase in the total compliance mean after the implementation of mNavigator (from 47% in the historic cohort to 56.2% in the intervention cohort). Most notable increases in provider protocol compliance were seen at proper staging at diagnosis and interim evaluation with 39.4% and 45.2% increases, respectively. Significant increases in provider protocol compliance were observed for every cycle of chemotherapy. Conclusion: The significant increases in protocol compliance in individual treatment sections and overall treatment after the implementation of mNavigator suggest the benefits of including mHealth in pediatric cancer treatment. The study limitations suggested the need for accurate data collection and outcome measurements. Additional studies are required to evaluate the impact of mNavigator on treatment outcomes.