globally , an estimated 2,50,000 children develop cancer each year , and 80% of them live in developing countries . cancer is a leading cause of disease worldwide , with an estimated 12.7 million new cancer cases occurring in 2008 . if recent trends in major cancers are seen globally in the future , and increasing populations , the burden of cancer will increase to 22.2 million new cases each year by 2030 . in india , the reported incidence rate of childhood cancer has increased over the last 25 years . in india , treatment options for children with cancer in developing countries are poor and limited , primarily due to financial constraints , poor compliance , and lack of supportive care . though the reasons for abandonment are complex and multifactorial , economic issue appears to be the main factor in abandonment . we analyzed the impact of financial support of two cancer support groups on treatment and abandonment in pediatric oncology . kanchi kamakoti childs trust hospital is a 200-bedded pediatric hospital and the department of pediatric hematology and oncology at kanchi kamakoti childs trust hospital is dedicated to the treatment of children with cancers such as leukemia , lymphomas , brain tumors , solid tumors such as neuroblastoma , wilms tumor , germ cell tumors as well as bone tumors such as ewings and osteosarcomas . the department witnesses about 200 outpatients and 70 inpatients per month with an average of 710 new cases being enrolled for therapy per month . this study is a retrospective review of children with cancer , funded by two projects ray of light foundation and pediatric lymphoma project and treated at kanchi kamakoti childs trust hospital from january 2010 to june 2013 . these two projects provide free treatment to children diagnosed with cancer , belonging to both lower and middle socioeconomic groups , thereby contributing to improving the outcome . these two cancer support groups at our institution are solely dedicated to financially support the treatment of children with cancer . the ray of light foundation is a volunteer group driven by a singular mission to help children in their fight against cancer . it takes over the entire treatment costs of children with cancer who can not afford treatment . this project is funded by private funding and covers all the costs of treatment including investigations and management . all children were risk stratified and treated as per the children 's oncology group ( cog ) protocols . patient data was collected in regards to underlying diagnosis , staging , outcome , and the expense of their treatment was assessed . during the study period , there were a total of 100 patients funded , 57 by ray of light foundation and 43 by pediatric lymphoma project , as against 70 children who were treated without financial aid . all of those treated without financial aid belonged to the upper middle ( ii ) and middle / lower middle ( iii ) status , where 60% of those who were in dire need of financial help belonged to lower / upper lower ( iv ) and lower ( v ) socioeconomic status and 40% in the middle / lower middle ( iii ) group . demographic details of children treated for cancer with and without financial aid at our institute the diagnosis of children treated under both the groups is as shown in table 2 . the total current survival is 80% in the financially aided group and 72% in the non - funded group including those who have completed treatment and those currently undergoing treatment . all the children were on regular treatment without any defaulters in those who were funded . the outcomes of children treated under both the groups are as shown in figure 1 . abandonment of treatment after initiating therapy was not seen in the financially supported group whereas abandonment of treatment after initiation was seen in one child in the non - funded group . the expenses per patient in leukemia and lymphomas for those who were funded are as shown in figure 2 . diagnosis of children in the funded and the non - funded groups outcomes of children treated under the financially aided and unaided group in resource - rich , high - income countries , nearly 80% of children with cancer can be cured by timely , intensive multimodality treatment and robust supportive care . however , in fact , only 20% of the world 's children with cancer live in these countries and the remaining 80% reside in resource - poor low - income nations and have a substantially lower chance of survival . about 80% in these resource - poor nations are either not diagnosed or are denied potentially life - saving treatment . four in five are from low and middle income countries where child cancer is just one of many health priorities struggling for resources . in our institute these were the families who otherwise would have considered the option of non - initiation of treatment if financial support was not given . we achieved a survival rate of around 80% , which is comparable in both the groups . the outcomes were good even in the lower socioeconomic class since they were also provided the full access to multimodality treatment and good supportive care . factors such as lack of infrastructure and refusal and abandonment of treatment due to social and economic factors such as limited financial resources , ignorance , and cancer illiteracy contribute to advanced presentations and poor outcomes in a developing country like india . refusal ( non - initiation ) and abandonment ( non - completion ) of treatment often exceeds all other causes of failure of treatment in a child with cancer in a developing country . the single most important factor that surpasses all others factors is the financial resource of the family . parents report financial burden as the main factor for abandonment since the true cost of therapy in childhood cancer includes the indirect costs ( food , lodging , transport , care of siblings , loss of income from loss of employment ) apart from the direct costs of therapy . the average family income is 13000 rupees per month overall and 3000 rupees per month in low socioeconomic groups . the monthly income of the family has been shown to be significantly related to abandonment rates . in our study , average family income was 6000 rupees per month in the funded group and 30000 rupees in the non - funded group . the financial support at our institute was provided to those belonging to this low socioeconomic status to undergo therapy irrespective of their risk status . the financial support by these two support groups also included the much - needed supportive care in febrile neutropenia , which resulted in early reporting to hospital during episodes of fever . since the financial support took care of all the direct costs involved in the treatment of cancer , it significantly reduced the burden on the family . this was reflected by the adherence to therapy by the parents in spite of other factors like ignorance and illiteracy . there was no withdrawal from therapy due to side effects or toxicity of treatment in view of the good supportive care . abandonment of treatment was seen in one child in the non - funded group due to financial restraints in the family and poor prognosis . deaths due to toxicity of treatment or infections ( 25% , 5/20 and 4/16 ) were comparable in both the funded and non - funded groups in our study reflecting on the good supportive care that could be given even to the lower socioeconomic patients . in a recent study from a tertiary healthcare establishment in india , of 762 children with acute lymphoblastic leukemia , 30% refused and another 15% abandoned treatment . in india , available data from tertiary centers shows abandonment rates varying from 17 - 62% . patients in low income countries benefit from good supportive care and financial support for treatment . besides intensive treatment with good supportive care , financial support also has an important impact on compliance and abandonment in all the socioeconomic strata of society . financial support from private cancer support groups also has its impact beyond the patient and family in reducing the burden on government institutions by non - governmental funding in private sector . improvement in the delivery of pediatric oncology care in developing countries could be improved by financial support from the private sector . as progress is being made to reduce infection - related childhood deaths in india , it should no longer be acceptable to allow children with cancer who have the potential for cure with appropriate treatment to be ignored when treatment abandonment occurs .
aims : to analyze the impact of two cancer support groups in the treatment and abandonment of childhood cancer.materials and methods : this is a retrospective review of children with cancer funded and non - funded who were treated at kanchi kamakoti childs trust hospital from 2010 to 2013 . 
 a total of 100 patients were funded , 57 by ray of light foundation and 43 by pediatric lymphoma project and 70 non-funded.results:the total current survival of 80% , including those who have completed treatment and those currently undergoing treatment , is comparable in both the groups . 
 abandonment of treatment after initiating therapy was not seen in the financially supported group whereas abandonment of treatment after initiation was seen in one child in the non - funded group.conclusions:besides intensive treatment with good supportive care , financial support also has an important impact on compliance and abandonment in all socioeconomic strata of society . financial support from private cancer support groups 
 also has its impact beyond the patient and family , in reducing the burden on government institutions by non - governmental funding in private sector . 
 improvement in the delivery of pediatric oncology care in developing countries could be done by financial support from the private sector .