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A multi\u2010institutional retrospective study was conducted to determine the predictive factors for TxRA among patients with osteosarcoma associated with survival outcomes across Southeast Asia (SEA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pediatric patients with osteosarcoma treated between January 1998 and December 2017 in four SEA pediatric oncology centers from three countries were studied. Nelson\u2013Aalen estimates, Kaplan\u2013Meier method, and Cox's proportion hazard model were applied to address the cumulative incidence, survival outcomes, and to identify prognostic factors associated with TxRA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From a total of 208 patients with osteosarcoma enrolled; 18 (8.7%) patients refused and 41 (19.7%) patients abandoned treatment. Income classification of countries, age at diagnosis, tumor size, disease extent, chemotherapy protocols, and types of surgery were associated with TxRA. Tumor size more than 15\u00a0cm was an independent risk factor associated with TxRA. The 5\u2010year overall and relapse\u2010free survivals were 49.4% and 50.4%, respectively. However, these rates declined further to 37.9% and 35.8%, respectively, when TxRA were considered as events. Tumor size larger than 15\u00a0cm and metastatic disease were independent risk factors associated with TxRA\u2010sensitive outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of TxRA was high in SEA, particularly in lower middle\u2010income countries. Factors associated with TxRA related to tumor burden. Treatment outcomes could be substantially improved by lowering the refusal and abandonment rates.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29556","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T15:54:04Z","timestamp":1642434844000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of treatment refusal and abandonment on survival outcomes in pediatric osteosarcoma in Southeast Asia: A multicenter study"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7960-5667","authenticated-orcid":false,"given":"Chalinee","family":"Monsereenusorn","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-0245","authenticated-orcid":false,"given":"Ana Patricia","family":"Alcasabas","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Department of Pediatrics University of the Philippines \u2010 Philippine General Hospital  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8333-1486","authenticated-orcid":false,"given":"Amos Hong Pheng","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery KK Women's and Children's Hospital  Singapore"},{"name":"Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4237-8904","authenticated-orcid":false,"given":"Shui Yen","family":"Soh","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore"},{"name":"Haematology\/Oncology Service, Department of Paediatric Subspecialties KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4251-423X","authenticated-orcid":false,"given":"Kenneth Wong Pak","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6086-9400","authenticated-orcid":false,"given":"Miriam","family":"Kimpo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology &amp; Bone Marrow and Cord Blood Transplantation University Children's Medical Institute, National University Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3637-2880","authenticated-orcid":false,"given":"Chetan","family":"Dhamne","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Tata Memorial Hospital, Homi Bhabha National Institute  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Blair","sequence":"additional","affiliation":[{"name":"Department of Global Pediatric Medicine St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-5331","authenticated-orcid":false,"given":"Catherine","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Global Pediatric Medicine St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2075-5561","authenticated-orcid":false,"given":"Apichat","family":"Photia","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5006-9810","authenticated-orcid":false,"given":"Piya","family":"Rujkijyanont","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5635-1238","authenticated-orcid":false,"given":"Chanchai","family":"Traivaree","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Phramongkutklao Hospital and Phramongkutklao College of Medicine  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9840-7682","authenticated-orcid":false,"given":"Sutipat","family":"Pairojboriboon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Phramongkutklao Hospital and Phramongkutklao College of Medicine  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2360-8946","authenticated-orcid":false,"given":"Carlos","family":"Rodriguez\u2010Galindo","sequence":"additional","affiliation":[{"name":"Department of Global Pediatric Medicine St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Asian Childhood Cancer Alliance Osteosarcoma Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/GO.20.00284"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1778.19262"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2173-1"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24809"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.7314\/APJCP.2014.15.22.9823"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2014.893596"},{"key":"e_1_2_11_8_1","unstructured":"MonsereenusornC FriedrichP AlcasabasP LamC Rodriguez\u2010GalindoC eds.Burden of pediatric solid tumors management in South\u2010East Asia countries. 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