The U.N.-ordered sanctions were imposed in 1990 after the invasion of Kuwait and remained in effect until 2003. During the sanctions, there was a widespread shortage of medications, including antibiotics and chemotherapeutic drugs.
"We wanted to determine if the reduction in the availability of chemotherapeutic agents resulted in actual changes in health outcomes for Iraqi children diagnosed with acute lymphocytic leukemia," said Haydar Frangoul, M.D., associate professor of Pediatrics and director of the Pediatric Stem Cell Transplant Program at Vanderbilt-Ingram Cancer Center.
Frangoul and colleagues from the Baghdad Medical College studied the medical records of 651 children diagnosed with acute lymphocytic leukemia (ALL) who were treated at the Children's Welfare Teaching Hospital in Baghdad.
Chemotherapy shortage was immediately observed after the implementation of the U.N. sanctions in 1990 but there was an incremental decrease in chemotherapy availability during the study period. The proportion of patients receiving less than 50 percent of their prescribed chemotherapy due to shortages increased from 20.1 percent between 1990 and 1994, to 54.3 percent between 2000 and 2002.
The researchers discovered that the overall survival rate was significantly higher for patients who received all of the prescribed dosages (80 percent versus 55 percent respectively). The difference in survival rates was significant whether the patients were considered to be in a standard risk group or a high-risk group.
Relapse was the most common cause of treatment failure, occurring in 217 of the 651 patients. "There was a significant inverse relationship between the amount of prescribed chemotherapy that was administered and the risk of relapse, i.e., the more prescribed chemotherapy received, the lower the risk of relapse," Frangoul explained.
"Despite the lack of some sophisticated laboratory and treatment options and aggressive supportive care, the outcomes for children who actually received the prescribed chemotherapy were similar to those found in developed countries. Our findings reinforce the concept that the most important factor in improving survival even in children with leukemia is providing them with an adequate supply of medications and not with expensive diagnostic equipment."