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Shoag J, Li Y, Getz KD, Huang YS, Hall M, Naranjo A, Richardson T, Desai AV, Umaretiya PJ, Aziz-Bose R, Kelly CA, Zheng DJ, Newman H, Zahler S, Aplenc R, Bagatell R, Bona K. Healthcare utilization disparities among children with high-risk neuroblastoma treated on Children's Oncology Group clinical trials. Pediatr Blood Cancer 2024:e31192. [PMID: 38997807 DOI: 10.1002/pbc.31192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Disparities in relapse and survival from high-risk neuroblastoma (HRNBL) persist among children from historically marginalized groups even in highly standardized clinical trial settings. Research in other cancers has identified differential treatment toxicity as one potential underlying mechanism. Whether racial and ethnic disparities in treatment-associated toxicity exist in HRNBL is poorly understood. METHODS This is a retrospective study utilizing a previously assembled merged cohort of children with HRNBL on Children's Oncology Group (COG) post-consolidation immunotherapy trials ANBL0032 and ANBL0931 at Pediatric Health Information System (PHIS) centers from 2005 to 2014. Race and ethnicity were categorized to reflect historically marginalized populations as Hispanic, non-Hispanic Black (NHB), non-Hispanic other (NHO), and non-Hispanic White (NHW). Associations between race-ethnicity and intensive care unit (ICU)-level care utilization as a proxy for treatment-associated toxicity were examined with log binomial regression and summarized as risk ratio (RR) and corresponding 95% confidence interval (CI). RESULTS The analytic cohort included 370 children. Overall, 88 (23.8%) patients required ICU-level care for a median of 3.0 days (interquartile range [IQR]: 1.0-6.5 days). Hispanic children had nearly three times the risk of ICU-level care (RR 3.1, 95% CI: 2.1-4.5; fully adjusted RR [aRR] 2.5, 95% CI: 1.6-3.7) compared to NHW children and the highest percentage of children requiring cardiovascular-driven ICU-level care. CONCLUSION Children of Hispanic ethnicity with HRNBL receiving clinical trial-delivered therapy were more likely to experience ICU-level care compared to NHW children. These data suggest that further investigation of treatment-related toxicity as a modifiable mechanism underlying outcome disparities is warranted.
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Affiliation(s)
- Jamie Shoag
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Cleveland Clinic, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly D Getz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuan-Shung Huang
- Healthcare Analytic Unit, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Children's Oncology Group Statistics & Data Center, Gainesville, Florida, USA
| | | | - Ami V Desai
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Puja J Umaretiya
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen A Kelly
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Zheng
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Haley Newman
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stacey Zahler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Cleveland Clinic, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Richard Aplenc
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rochelle Bagatell
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Ilcisin L, Han R, Krailo M, Shulman DS, Weil BR, Weldon CB, Umaretiya P, Aziz-Bose R, Greenzang KA, Gorlick R, Reed DR, Randall RL, Nadel H, Binitie O, Dubois SG, Janeway KA, Bona K. Poverty, race, ethnicity, and survival in pediatric nonmetastatic osteosarcoma: a Children's Oncology Group report. J Natl Cancer Inst 2024:djae103. [PMID: 38926133 DOI: 10.1093/jnci/djae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Children living in poverty and those of marginalized race or ethnicity experience inferior disease outcomes across many cancers. Whether survival disparities exist in osteosarcoma is poorly defined. We investigated the association between race, ethnicity, and proxied poverty exposures and event-free and overall survival for children with nonmetastatic osteosarcoma receiving care on a cooperative group trial. METHODS We conducted a retrospective cohort study of US patients with nonmetastatic, osteosarcoma aged 5-21 years enrolled on the Children's Oncology Group trial AOST0331. Race and ethnicity were categorized to reflect historically marginalized populations, as Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. Poverty was proxied at the household and neighborhood levels. Overall survival and event-free survival functions of time from trial enrollment were estimated using the Kaplan-Meier method. Hypotheses of associations between risks for event-free survival, death, and postrelapse death with race and ethnicity were assessed using log-rank tests. RESULTS Among 758 patients, 25.6% were household-poverty and 28.5% neighborhood-poverty exposed. Of the patients, 21% of children identified as Hispanic, 15.4% non-Hispanic Black, 5.3% non-Hispanic Other, and 54.0% non-Hispanic White. Neither household or neighborhood poverty nor race and ethnicity were statistically significantly associated with risks for event-free survival or death. Postrelapse risk for death differed statistically significantly across race and ethnicity with non-Hispanic Black patients at greatest risk (4-year postrelapse survival 35.7% Hispanic vs 13.0% non-Hispanic Black vs 43.8% non-Hispanic Other vs 38.9% non-Hispanic White; P = .0046). CONCLUSIONS Neither proxied poverty exposures or race and ethnicity were associated with event-free survival or overall survival, suggesting equitable outcomes following frontline osteosarcoma trial-delivered therapy. Non-Hispanic Black children experienced statistically significant inferior postrelapse survival. Investigation of mechanisms underlying postrelapse disparities are paramount.
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Affiliation(s)
- Lenka Ilcisin
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruxu Han
- Children's Oncology Group, Monrovia, CA, USA
| | - Mark Krailo
- Children's Oncology Group, Arcadia, CA, USA
- Department of Population and Public Health Sciences Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David S Shulman
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Puja Umaretiya
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Katie A Greenzang
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Richard Gorlick
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Damon R Reed
- Division of Pediatric Solid Tumors, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Helen Nadel
- Division of Radiology, Lucille Packard Children's Hospital at Stanford University, Stanford, CA, USA
| | - Odion Binitie
- Department of Surgery, Moffitt Cancer Center, Tampa, FL, USA
| | - Steven G Dubois
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Katherine A Janeway
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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Andrist E, Clarke RG, Phelps KB, Dews AL, Rodenbough A, Rose JA, Zurca AD, Lawal N, Maratta C, Slain KN. Understanding Disparities in the Pediatric ICU: A Scoping Review. Pediatrics 2024; 153:e2023063415. [PMID: 38639640 DOI: 10.1542/peds.2023-063415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health disparities are pervasive in pediatrics. We aimed to describe disparities among patients who are likely to be cared for in the PICU and delineate how sociodemographic data are collected and categorized. METHODS Using MEDLINE as a data source, we identified studies which included an objective to assess sociodemographic disparities among PICU patients in the United States. We created a review rubric, which included methods of sociodemographic data collection and analysis, outcome and exposure variables assessed, and study findings. Two authors reviewed every study. We used the National Institute on Minority Health and Health Disparities Research Framework to organize outcome and exposure variables. RESULTS The 136 studies included used variable methods of sociodemographic data collection and analysis. A total of 30 of 124 studies (24%) assessing racial disparities used self- or parent-identified race. More than half of the studies (52%) dichotomized race as white and "nonwhite" or "other" in some analyses. Socioeconomic status (SES) indicators also varied; only insurance status was used in a majority of studies (72%) evaluating SES. Consistent, although not uniform, disadvantages existed for racial minority populations and patients with indicators of lower SES. The authors of only 1 study evaluated an intervention intended to mitigate health disparities. Requiring a stated objective to evaluate disparities aimed to increase the methodologic rigor of included studies but excluded some available literature. CONCLUSIONS Variable, flawed methodologies diminish our understanding of disparities in the PICU. Meaningfully understanding and addressing health inequity requires refining how we collect, analyze, and interpret relevant data.
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Affiliation(s)
- Erica Andrist
- Division of Pediatric Critical Care Medicine
- Departments of Pediatrics
| | - Rachel G Clarke
- Division of Pediatric Critical Care Medicine, Upstate University Hospital, Syracuse, New York
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York
| | - Kayla B Phelps
- Division of Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Alyssa L Dews
- Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
- Susan B. Meister Child Health and Adolescent Research Center, University of Michigan, Ann Arbor, Michigan
| | - Anna Rodenbough
- Division of Pediatric Critical Care Medicine, Children's Hospital of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jerri A Rose
- Pediatric Emergency Medicine
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adrian D Zurca
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nurah Lawal
- Stepping Stones Pediatric Palliative Care Program, C.S. Mott Children's Hospital, Ann Arbor, Michigan
- Departments of Pediatrics
| | - Christina Maratta
- Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine N Slain
- Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Newman H, Li Y, Huang YV, Elgarten CW, Myers RM, Ruiz J, Zheng DJ, Leahy AB, Aftandilian C, Arnold SD, Bona K, Gramatges MM, Heneghan MB, Maloney KW, Modi AJ, Mody RJ, Morgan E, Rubnitz J, Winick N, Wilkes JJ, Seif AE, Fisher BT, Aplenc R, Getz KD. Household income and health-related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research. Cancer Med 2024; 13:e6966. [PMID: 38572962 PMCID: PMC10993703 DOI: 10.1002/cam4.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Examine the influence of household income on health-related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML). DESIGN Secondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States. EXPOSURE Household income was self-reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity. OUTCOME Caregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey. RESULT Children with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2-20.2). Seven percent of enrolled patients presented with high acuity (ICU-level care in the first 72 h), and 16% had high toxicity (any ICU-level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction. CONCLUSIONS While primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.
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Affiliation(s)
- Haley Newman
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yimei Li
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuan‐Shung V. Huang
- Department of Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Caitlin W. Elgarten
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Regina M. Myers
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jenny Ruiz
- Division of Hematology‐Oncology, Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel J. Zheng
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Alison Barz Leahy
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Catherine Aftandilian
- Division of Pediatric Hematology‐Oncology, Stem Cell Transplant and Regenerative Medicine, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | - Staci D. Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaEmory University School of MedicineAtlantaGeorgiaUSA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - M. Monica Gramatges
- Division of Pediatric Hematology‐Oncology, Department of PediatricsTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Mallorie B. Heneghan
- Division of Pediatric Hematology‐Oncology, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kelly W. Maloney
- Department of Pediatrics‐Hematology/Oncology and Bone Marrow Transplant, University of Colorado Cancer CenterChildren's Hospital ColoradoAuroraColoradoUSA
| | - Arunkumar J. Modi
- Division of Hematology Oncology, Department of PediatricsUniversity of Arkansas for Medical Sciences, Arkansas Children's HospitalLittle RockArkansasUSA
| | - Rajen J. Mody
- Department of PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elaine Morgan
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey Rubnitz
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Naomi Winick
- Department of Pediatric Hematology OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jennifer J. Wilkes
- Division of Cancer and Blood Disorders, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Alix E. Seif
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brian T. Fisher
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Division of Infectious Disease, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Richard Aplenc
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kelly D. Getz
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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MCCONNELL MARGARET, AGARWAL SUMIT, HANSON ERIKA, MCCRADY ERIN, PARKER MARGARETG, BONA KIRA. Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings. Milbank Q 2024; 102:64-82. [PMID: 37994263 PMCID: PMC10938935 DOI: 10.1111/1468-0009.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.
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Affiliation(s)
| | | | - ERIKA HANSON
- Center for Health Law and Policy Innovation, Harvard Law School
| | - ERIN MCCRADY
- Center for Health Law and Policy Innovation, Harvard Law School
| | - MARGARET G. PARKER
- Child Health Equity CenterUniversity of Massachusetts Chan Medical School
| | - KIRA BONA
- Harvard Medical School
- Dana‐Farber Cancer Institute
- Boston Children's Hospital
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Davitt M, Gennarini L, Loeb DM, Hosgood HD. Drivers of Differential Time to Diagnosis in Pediatric ALL Tied to Race and Ethnicity. J Pediatr Hematol Oncol 2023; 45:e879-e884. [PMID: 37526394 PMCID: PMC10564086 DOI: 10.1097/mph.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/21/2023] [Indexed: 08/02/2023]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with diagnosis preceded by symptoms that may include fever, weight loss, fatigue, bleeding, and bruising. Timely diagnosis and treatment of ALL may lead to improved outcomes and reduced morbidity from associated complications, including tumor lysis syndrome, hyperviscosity, and stroke. We performed a retrospective cohort analysis of 274 pediatric pre-B cell ALL and acute lymphoblastic lymphoma patients within Montefiore Health System to determine whether there were factors associated with time from symptom onset to diagnosis. The median time to diagnosis for all patients was 11.5 days (interquartile range: 7.8, 14.3). Those with Medicaid insurance (n=189) were diagnosed sooner than those with private/self-pay insurance (n=85) (median of 10 vs. 16 days; P =0.05). English and other language speakers experienced fewer median days from symptom onset to diagnosis date compared with Spanish speakers (11 vs. 7 vs. 14; P =0.05). Insurance status may impact the time to diagnosis to a greater degree in non-Hispanic patients, while the English language and female sex may represent a greater advantage to Hispanic patients. Insurance status and language preference may impact the time to diagnosis of pediatric ALL. There is a further need to confirm our findings and to study possible causes driving these disparities.
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Affiliation(s)
- Meghan Davitt
- Division of Pediatric Hematology, Oncology, Transplant and Cellular therapy, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Lisa Gennarini
- Division of Pediatric Hematology, Oncology, Transplant and Cellular therapy, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - David M. Loeb
- Division of Pediatric Hematology, Oncology, Transplant and Cellular therapy, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
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7
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Gramatges MM. Poverty and health equity in childhood leukemia. Blood 2023; 142:211-212. [PMID: 37471111 PMCID: PMC10375267 DOI: 10.1182/blood.2023020565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
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8
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Evans EM, Lin J, Sanchez-Alvarez J, Agrawal AK, Winestone LE. Disparities in household material hardship, financial toxicity, and income loss in pediatric cancer. Pediatr Blood Cancer 2023:e30496. [PMID: 37394628 DOI: 10.1002/pbc.30496] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. METHODS Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change. RESULTS Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity. CONCLUSION HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH.
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Affiliation(s)
- Erica M Evans
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Jackie Lin
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jacklyn Sanchez-Alvarez
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
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9
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Graetz DE. The most vulnerable pediatric cancer patients. THE LANCET REGIONAL HEALTH - AMERICAS 2023; 21:100480. [PMID: 37008198 PMCID: PMC10064219 DOI: 10.1016/j.lana.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/28/2023]
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10
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Aristizabal P, Thornburg CD, Young J. At the border: A call to action for health equity for children with leukemia. Cancer 2023; 129:1159-1161. [PMID: 36805948 PMCID: PMC10416232 DOI: 10.1002/cncr.34629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We invite public health policy makers to be cognizant of the importance of where persons reside and consider focusing efforts to improve cancer outcomes in rural areas with concentrated poverty. We call for the attention of public health leaders and healthcare providers in both the US and Mexico to mitigate the health disparities suffered by immigrants, a population that plays a vital role for the economies and social fabric of these two countries.
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Affiliation(s)
- Paula Aristizabal
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA, USA
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, La Jolla, CA, USA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
- University of California San Diego Clinical and Translational Research Institute, Dissemination and Implementation Science Center, La Jolla, CA, USA
| | - Courtney D. Thornburg
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA, USA
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, La Jolla, CA, USA
| | - Janine Young
- University of California San Diego, Department of Pediatrics, Division of Academic General Pediatrics, La Jolla, CA, USA
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Castellanos MI, Oluyomi AO, Chambers TM, Gramatges MM, Winestone LE, Lupo PJ, Scheurer ME. Ethnic disparities in childhood leukemia survival by border residence: A Texas population-based analysis. Cancer 2023; 129:1276-1286. [PMID: 36805949 DOI: 10.1002/cncr.34636] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The US-Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas-Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. METHODS The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan-Meier methods. RESULTS During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5-year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. CONCLUSIONS Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs.
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Affiliation(s)
- Maria I Castellanos
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abiodun O Oluyomi
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany M Chambers
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lena E Winestone
- Division of Allergy, Immunology, and Blood and Marrow Transplant, University of California-San Francisco Benioff Children's Hospitals, San Francisco, California, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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12
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Hall AG, Winestone LE, Sullivan EM, Wu Q, Lamble AJ, Walters MC, Aguayo-Hiraldo P, Conde LB, Coker TR, Dornsife D, Keating AK, Merino DM, Ramsey B, Park JR, Agrawal AK. Access to Chimeric Antigen Receptor T Cell Clinical Trials in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult Acute Lymphobastic Leukemia Patients. Transplant Cell Ther 2023:S2666-6367(23)01198-3. [PMID: 36966871 DOI: 10.1016/j.jtct.2023.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is a promising approach to improve survival for children and adults with relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL), but these clinical trials might not be equally accessible to patients of low socioeconomic status (SES) or to patients from racial or ethnic minority groups. We sought to describe the sociodemographic characteristics of pediatric and adolescent and young adult (AYA) patients enrolled in CAR-T clinical trials and to compare these characteristics to those of other patients with r/r B-ALL. We conducted a multicenter retrospective cohort study at 5 pediatric consortium sites to compare the sociodemographic characteristics of patients treated and enrolled in CAR-T trials at their home institution, other patients with r/r B-ALL treated at these sites, and patients referred from an external hospital for CAR-T trials. The patients were age 0 to 27 years with r/r B-ALL treated at 1 of the consortium sites between 2012 and 2018. Clinical and demographic data were collected from the electronic health record. We calculated distance from home to treating institution and assigned SES scores based on census tract. Among the 337 patients treated for r/r B-ALL, 112 were referred from an external hospital to a consortium site and enrolled in a CAR-T trial and 225 were treated primarily at a consortium site, with 34% enrolled in a CAR-T trial. Patients treated primarily at a consortium site had similar characteristics regardless of trial enrollment. Lower proportions of Hispanic patients (37% versus 56%; P = .03), patients whose preferred language was Spanish (8% versus 22%; P = .006), and publicly insured patients (38% versus 65%; P = .001) were referred from an external hospital than were treated primarily at a consortium site and enrolled in a CAR-T trial. Patients who are Hispanic, Spanish-speaking, or publicly insured are underrepresented in referrals from external hospitals to CAR-T centers. External provider implicit bias also may influence referral of these patients. Establishing partnerships between CAR-T centers and external hospital sites may improve provider familiarity, patient referral, and patient access to CAR-T clinical trials.
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Affiliation(s)
- Anurekha G Hall
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Lena E Winestone
- Division of Pediatric Allergy, Immunology, and Blood & Marrow Transplantation, UCSF Benioff Children's Hospitals, San Francisco, California
| | - Erin M Sullivan
- Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington
| | - Qian Wu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Adam J Lamble
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Mark C Walters
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California; USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lourdes Baez Conde
- USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Tumaini R Coker
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington
| | | | - Amy K Keating
- Pediatric Blood and Marrow Transplantation, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Bonnie Ramsey
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Julie R Park
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Anurag K Agrawal
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
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13
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Gupta S, Dai Y, Chen Z, Winestone LE, Teachey DT, Bona K, Aplenc R, Rabin KR, Zweidler-McKay P, Carroll AJ, Heerema NA, Gastier-Foster J, Borowitz MJ, Wood BL, Maloney KW, Mattano LA, Larsen EC, Angiolillo AL, Burke MJ, Salzer WL, Winter SS, Brown PA, Guest EM, Dunsmore KP, Kairalla JA, Winick NJ, Carroll WL, Raetz EA, Hunger SP, Loh ML, Devidas M. Racial and ethnic disparities in childhood and young adult acute lymphocytic leukaemia: secondary analyses of eight Children's Oncology Group cohort trials. Lancet Haematol 2023; 10:e129-e141. [PMID: 36725118 PMCID: PMC9951049 DOI: 10.1016/s2352-3026(22)00371-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have identified racial and ethnic disparities in childhood acute lymphocytic leukaemia survival. We aimed to establish whether disparities persist in contemporaneous cohorts and, if present, are attributable to differences in leukaemia biology or insurance status. METHODS Patients with newly diagnosed acute lymphocytic leukaemia in inpatient and outpatient centres in the USA, Canada, Australia, and New Zealand, aged 0-30 years, who had race or ethnicity data available, enrolled on eight completed Children's Oncology Group trials (NCT00103285, NCT00075725, NCT00408005, NCT01190930, NCT02883049, NCT02112916, NCT02828358, and NCT00557193) were included in this secondary analysis. Race and ethnicity were categorised as non-Hispanic White, Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic other. Event-free survival and overall survival were compared across race and ethnicity groups. The relative contribution of clinical and biological disease prognosticators and insurance status was examined through multivariable regression models, both among the entire cohort and among those with B-cell lineage versus T-cell lineage disease. FINDINGS Between Jan 1, 2004, and Dec 31, 2019, 24 979 eligible children, adolescents, and young adults with acute lymphocytic leukaemia were enrolled, of which 21 152 had race or ethnicity data available. 11 849 (56·0%) were male and 9303 (44·0%) were female. Non-Hispanic White patients comprised the largest racial or ethnic group (13 872 [65·6%]), followed by Hispanic patients (4354 [20·6%]), non-Hispanic Black patients (1517 [7·2%]), non-Hispanic Asian (n=1071 [5·1%]), and non-Hispanic other (n=338 [1·6%]). 5-year event-free survival was 87·4% (95% CI 86·7-88·0%) among non-Hispanic White patients compared with 82·8% (81·4-84·1%; hazard ratio [HR] 1·37, 95% CI 1·26-1·49; p<0·0001) among Hispanic patients and 81·8% (79·3-84·0; HR 1·45, 1·28-1·65; p<0·0001) among non-Hispanic Black patients. Non-hispanic Asian patients had a 5-year event-free survival of 88·1% (95% CI 85·5-90·3%) and non-Hispanic other patients had a survival of 82·8% (76·4-87·6%). Inferior event-free survival among Hispanic patients was substantially attenuated by disease prognosticators and insurance status (HR decreased from 1·37 [1·26-1·49; p<0·0001] to 1·11 [1·00-1·22; p=0·045]). The increased risk among non-Hispanic Black patients was minimally attenuated (HR 1·45 [1·28-1·65; p<0·0001] to 1·32 [1·14-1·52; p<0·0001]). 5-year overall survival was 93·6% (91·5-95·1%) in non-Hispanic Asian patients, 93·3% (92·8-93·7%) in non-Hispanic White patients, 89·9% (88·7-90·9%) in Hispanic, 89·7% (87·6-91·4%) in non-Hispanic Black patients, 88·9% (83·2-92·7%) in non-Hispanic other patients. Disparities in overall survival were wider than event-free survival (eg, among non-Hispanic other patients, the HR for event-free survival was 1·43 [1·10-1·85] compared with 1·74 [1·27-2·40] for overall survival). Disparities were restricted to patients with B-cell acute lymphocytic leukaemia, no differences in event-free survival or overall survival were seen in the T-cell acute lymphocytic leukaemia group. INTERPRETATION Substantial disparities in outcome for B-cell acute lymphocytic leukaemia persist by race and ethnicity, but are not observed in T-cell acute lymphocytic leukaemia. Future studies of relapsed patients, access to and quality of care, and other potential aspects of structural racism are warranted to inform interventions aimed at dismantling racial and ethnic disparities. FUNDING National Cancer Institute and St Baldrick's Foundation.
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Affiliation(s)
- Sumit Gupta
- Cancer Research Program, ICES, Toronto, ON, Canada; Institute for Health Policy, Evaluation and Management and Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Yunfeng Dai
- Biostatistics, University of Florida, Gainesville, FL, USA
| | - Zhiguo Chen
- Biostatistics, University of Florida, Gainesville, FL, USA
| | - Lena E Winestone
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Comprehensive Cancer Centre, University of California, San Francisco, San Francisco, CA, USA
| | - David T Teachey
- Cellular Therapy and Transplant Section and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Richard Aplenc
- Cellular Therapy and Transplant Section and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen R Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Patrick Zweidler-McKay
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA; University of Texas MD Anderson UT Health Graduate School of Biomedical Sciences, Houston, TX, USA; ImmunoGen, Waltham, MA, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - Julie Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, Ohio State University School of Medicine, Columbus, OH, USA
| | | | - Brent L Wood
- Department of Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kelly W Maloney
- Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Eric C Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME, USA
| | - Anne L Angiolillo
- Division of Oncology, Centre for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Michael J Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wanda L Salzer
- US Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
| | - Stuart S Winter
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Erin M Guest
- Genomic Medicine Centre, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kimberley P Dunsmore
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Naomi J Winick
- Simmons Cancer Center and Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William L Carroll
- Department of Pediatrics, NYU Langone Health, New York City, NY, USA
| | - Elizabeth A Raetz
- Department of Pediatrics, NYU Langone Health, New York City, NY, USA
| | - Stephen P Hunger
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Comprehensive Cancer Centre, University of California, San Francisco, San Francisco, CA, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
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14
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Ohlsen TJD, Doody DR, Mueller BA, Desai AD, Chow EJ. Population-Based Impact of Rurality and Neighborhood-Level Socioeconomic Disadvantage on Pediatric Cancer Mortality in Washington State. Cancer Epidemiol Biomarkers Prev 2023; 32:141-148. [PMID: 36343539 PMCID: PMC9839485 DOI: 10.1158/1055-9965.epi-22-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childhood cancer-related mortality differs by socioeconomic factors, but the impact of residential location, including rurality and neighborhood-level socioeconomic disadvantage, is not well-characterized. METHODS This retrospective cohort study linked Washington State cancer registry data (1992-2013) to state birth (1974-2013) and death records (1992-2013) to identify residents <20 years diagnosed with cancer (n = 4,306). Census-based rural-urban commuting area codes and Area Deprivation Index (ADI) defined rural residence and neighborhood socioeconomic disadvantage at time of cancer diagnosis, respectively. Neighborhoods in the highest state ADI quintile were classified as the most disadvantaged. Kaplan-Meier estimates and Cox hazards models, adjusted for key characteristics, were used to compare mortality by rural and ADI classification. RESULTS Five-year overall survival for children from non-rural low ADI neighborhoods (referent) was 80.9%±0.8%, versus 66.4%±2.9% from non-rural high ADI neighborhoods, 69.4%±3.8% from rural low ADI neighborhoods, and 66.9%±3.8% from rural high ADI neighborhoods (P < 0.01 for each comparison versus referent). Compared with the referent group, children from comparator neighborhoods had a greater mortality risk: Rural low ADI [hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.12-2.02], rural high ADI (HR, 1.53; 95% CI, 1.16-2.01), and non-rural high ADI (HR, 1.64; 95% CI, 1.32-2.04). Associations of ADI and rurality with mortality varied in sub-analyses by cancer type. CONCLUSIONS Children with cancer living in rural and/or socioeconomically disadvantaged neighborhoods at diagnosis experienced greater mortality relative to those without either factor. IMPACT Future investigation is needed to examine how rurality and poverty potentially impact healthcare utilization and health-related outcomes in pediatric oncology.
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Affiliation(s)
- Timothy J. D. Ohlsen
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute,Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - David R. Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Center
| | - Beth A. Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Center,Department of Epidemiology, University of Washington
| | - Arti D. Desai
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - Eric J. Chow
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Public Health Sciences Division, Fred Hutchinson Cancer Center
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15
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Janitz AE, Barber R, Campbell JE, Xu C, Pokala HR, Blanchard J, McNall-Knapp RY. Measuring disparities in event-free survival among children with acute lymphoblastic leukemia in an academic institute in Oklahoma, 2005-2019. Cancer Epidemiol 2022; 81:102275. [PMID: 36215916 PMCID: PMC10079780 DOI: 10.1016/j.canep.2022.102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. While there have been successes in the treatment of leukemia, less information is available on reasons for disparities in event-free survival (EFS) among underserved populations. METHODS We partnered with a children's hospital at an academic institution to abstract data from the institution's cancer registry, the state cancer registry, and electronic medical records on cancer diagnosis, treatment, and outcomes for children with ALL (n = 275) diagnosed from 2005 to 2019 prior to age 20. We evaluated the relation between 1) race/ethnicity, 2) distance to the children's hospital, and 3) area deprivation with EFS, defined as time from diagnosis to relapse, death, or the end of the study period. We evaluated differences in EFS using Kaplan-Meier analysis with the log-rank test. We used the Cox Proportional Hazards Model for multivariable survival analyses. RESULTS Most children were diagnosed with ALL under five years of age (45%) and with Pre-B ALL (87%). Twelve percent of children experienced a relapse and 5% died during induction or remission. EFS at 5 years was 82%. Non-Hispanic (NH) Black children had worse, though imprecise, EFS compared to NH White children (Adjusted Hazard Ratio: 2.07, 95% CI: 0.80, 5.38). Children residing in areas with higher deprivation had a higher adjusted hazard of poor outcomes compared to the least deprived areas, though estimates were imprecise (2nd quartile HR: 1.51, 3rd quartile: 1.85, 4th quartile: 1.62). We observed no association between distance to the children's hospital and EFS. CONCLUSION We observed poorer EFS for NH Black children and children residing in areas with high deprivation, though the estimates were not statistically significant. Our next steps include further evaluating socioeconomic factors in both rural and urban children to identify disparities in outcomes for children with ALL and other childhood cancers.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Rylee Barber
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Hanumantha R Pokala
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Jessica Blanchard
- Center for Applied Social Research, College of Arts and Sciences, University of Oklahoma, Norman, OK, 73072, United States.
| | - René Y McNall-Knapp
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
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Rivera-Luna R, Perez-Vera P, Galvan-Diaz C, Velasco-Hidalgo L, Olaya-Vargas A, Cardenas-Cardos R, Aguilar-Ortiz M, Ponce-Cruz J. Triple-hit explanation for the worse prognosis of pediatric acute lymphoblastic leukemia among Mexican and Hispanic children. Front Oncol 2022; 12:1072811. [PMID: 36531028 PMCID: PMC9747921 DOI: 10.3389/fonc.2022.1072811] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 04/06/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common malignancy among Mexican and Hispanic children and the first cause of death by disease in Mexico. We propose a "triple-hit" explanation for the survival gap affecting this population. The first hit can be attributed to epidemiology and social, cultural, and economic burdens. The second hit refers to cancer biology, with a high incidence of unfavorable genetic characteristics associated with an unfavorable response to treatment and, subsequently, poor survival. Finally, the third hit relates to sub-optimal treatment and support. Society and culture, leukemia biology, and treatment approach limitations are key factors that should not be seen apart and must be considered comprehensively in any strategy to improve the prognosis of Mexican and Hispanic children with ALL.
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Affiliation(s)
- Roberto Rivera-Luna
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
- Progenitor and Hematopoietic Cell Transplant Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - Patricia Perez-Vera
- Laboratory of Genetics and Cancer, National Institute of Pediatrics, Mexico City, Mexico
| | - Cesar Galvan-Diaz
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Alberto Olaya-Vargas
- Progenitor and Hematopoietic Cell Transplant Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Marco Aguilar-Ortiz
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
| | - Jesus Ponce-Cruz
- Pediatric Oncology Unit, ABC Medical Center, Mexico City, Mexico
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17
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Muñiz JP, Woodhouse JP, Hughes AE, Pruitt SL, Rabin KR, Scheurer ME, Lupo PJ, Schraw JM. Residence in a Latinx enclave and end-induction minimal residual disease positivity among children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2022; 39:650-657. [PMID: 35262447 PMCID: PMC9458766 DOI: 10.1080/08880018.2022.2047850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Racial and ethnic inequities in survival persist for children with acute lymphoblastic leukemia (ALL). In the US, there are strong associations between SES, race/ethnicity, and place of residence. This is evidenced by ethnic enclaves: neighborhoods with high concentrations of ethnic residents, immigrants, and language isolation. The Latinx enclave index (LEI) can be used to investigate how residence in a Latinx enclave is associated with health outcomes. We studied the association between LEI score and minimal residual disease (MRD) in 142 pediatric ALL patients treated at Texas Children's Hospital. LEI score was associated with end-induction MRD positivity (OR per unit increase 1.63, CI 1.12-2.46). There was also a significant trend toward increased odds of MRD positivity among children living in areas with the highest enclave index scores. MRD positivity at end of induction is associated with higher incidence of relapse and lower overall survival among children with ALL; future studies are needed to elucidate the exact causes of these findings and to improve ALL outcomes among children residing within Latinx enclaves.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2022.2047850.
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Affiliation(s)
- Joshua P Muñiz
- Department of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John P Woodhouse
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Amy E Hughes
- Department of Population and Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karen R Rabin
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Philip J Lupo
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremy M Schraw
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
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18
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Chalfant V, Riveros C, Stec AA. Effect of social disparities on 10 year survival in pediatric patients with Wilms' tumor. Cancer Med 2022; 12:3452-3459. [PMID: 35946133 PMCID: PMC9939224 DOI: 10.1002/cam4.5124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To stratify 10-year survival outcomes by degree of social disparities in pediatric Wilms' tumor patients. We applied the Social Deprivation Index (SDI) to survival outcomes from the national SEER database to elucidate the effects of lower socioeconomics on cancer survival. METHODS A retrospective cohort study was performed using the national Surveillance, Epidemiology, and End Results (SEER) oncology registry from 1975 to 2016 based on county-level data. Pediatric patients (<18 years old) with a diagnosis of WT (C64.9) and confirmed based on histology codes (8960/8963) were included. SDI scores were calculated for each patient and initially divided into quintiles. Patients were delineated into high-risk (>60th percentile/more deprived) or low-risk (<60th percentile/less deprived) groups. Statistics were assessed using Fisher's exact test, Student's t-test, and Kaplan-Meier assessed survival differences with log-rank test for trend. RESULTS A total of 3406 patients were included with 1366 patients reported in the high-risk group and 2040 patients in the low-risk group. Quintile data demonstrated a stratification in survival based on socioeconomic status. Patients in more socially deprived counties were significantly (p = 0.035) more likely to have worse overall survival compared with those living in less deprived areas at 10-year (87.3% vs 89.3%) follow-up. CONCLUSIONS 10-year overall and cancer-specific survival data for patients with Wilms' tumor stratify by socioeconomic lines. This represents an area that needs to be addressed in this pediatric oncologic population. Patients from more socially deprived areas have significantly worse 10-year overall survival rates and noticeably different 10-year cancer-specific survival rates.
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Affiliation(s)
- Victor Chalfant
- Department of UrologyCreighton University School of MedicineOmahaNebraskaUSA
| | - Carlos Riveros
- Department of UrologyUniversity of Florida HealthJacksonvilleFloridaUSA
| | - Andrew A. Stec
- Division of UrologyNemours Children's HealthJacksonvilleFloridaUSA
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19
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Pedersen LH, Østergaard A, Bank V, Nersting J, Tuckuviene R, Wehner PS, Albertsen BK, Degn M, Als-Nielsen BET, Larsen HB, Schmiegelow K, Dalton SO. Socioeconomic position and maintenance therapy in children with acute lymphoblastic leukemia: A national cohort study. Pediatr Blood Cancer 2022; 69:e29508. [PMID: 34931732 DOI: 10.1002/pbc.29508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic differences in survival among children with acute lymphoblastic leukemia (ALL) have been reported in high-income countries and there is an unmet need for strategies to identify vulnerable patient subgroups. Reported differences in survival for children from families with different socioeconomic positions seem to arise when starting maintenance therapy. This could reflect reduced physician's compliance or family adherence to maintenance therapy. METHODS This nationwide cohort study with extensive monitoring of systemic methotrexate (MTX)/6-mercaptopurine (6MP) dosing and metabolite levels, retrospectively investigated 173 Danish children treated according to The Nordic Society for Pediatric Hematology and Oncology ALL2008 protocol from 2008 to 2016. RESULTS Significantly lower prescribed doses of MTX and 6MP were seen in the children in families with short parental education (short vs. medium vs. higher education: mMTX: 13.8, 16.2, and 18.6 mg/m2 /week; p < .01; m6MP: 47.4, 64.9, and 66.1 mg/m2 /day; p = .03) or parents unemployed/not in workforce (unemployed/not in workforce vs. mixed vs. at work: mMTX: 15.0, 19.9, and 17.2 mg/m2 /week; p < .01; m6MP: 54.8, 72.0, and 65.1 mg/m2 /day; p < .01). When assessing family adherence by analyzing MTX and 6MP metabolite levels, including per prescribed dose of MTX and 6MP, we found no significant differences by levels of parental education, affiliation to work market, or income (p > .05 for all comparisons). CONCLUSIONS These results indicate that inferior physician compliance to protocol recommendations on drug dosage rather than families' adherence to therapy may contribute to the association between socioeconomic position and cure rates in childhood ALL, although precise mechanisms remain to be explored.
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Affiliation(s)
- Line Hjøllund Pedersen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anna Østergaard
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Victoria Bank
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Nersting
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Ruta Tuckuviene
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Birgitte Klug Albertsen
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Matilda Degn
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | | | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
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20
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Hendricks M, Cois A, Geel J, du Plessis J, Bassingthwaighte M, Naidu G, Rowe B, Büchner A, Omar F, Thomas K, Uys R, van Zyl A, van Heerden J, Mahlachana N, Vermeulen J, Davidson A, Frazier AL, Donald K, Kruger M. Malignant extracranial germ cell tumours: A first national report by the South African Children's Cancer Study Group. Pediatr Blood Cancer 2022; 69:e29543. [PMID: 34971072 DOI: 10.1002/pbc.29543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol. METHODS A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy-proven MEGCTs from birth up to and including 16 years of age. RESULTS Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (hazard ratio [HR] 0.284, p = .037) and higher socio-economic status (SES) (HR 0.071, p = .039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I: 96%; stage II: 94.3%; stage III: 75.5% (p = .017) and stage IV (60.1%; p < .001). There was a significant association between earlier stage at presentation and higher SES (p = .03). Patients with a serum alpha-fetoprotein (AFP) level of more than 33,000 ng/ml at diagnosis had significantly poorer outcomes (p = .002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p < .001). CONCLUSIONS The cohort demonstrated a 5-year OS of 80.3% with an event-free survival (EFS) of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000 ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide.
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Affiliation(s)
- Marc Hendricks
- Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Annibale Cois
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Geel
- Division of Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Johan du Plessis
- Division of Paediatric Haematology Oncology, Department of Paediatrics, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
| | - Mairi Bassingthwaighte
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Gita Naidu
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Biance Rowe
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Ané Büchner
- Paediatric Haematology Oncology, Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Tshwane, South Africa
| | - Fareed Omar
- Paediatric Haematology Oncology, Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Tshwane, South Africa
| | - Karla Thomas
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Frere Hospital, East London, South Africa
| | - Ronelle Uys
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Anel van Zyl
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Jaques van Heerden
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Ngoakoana Mahlachana
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Johani Vermeulen
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Alan Davidson
- Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - A Lindsay Frazier
- Paediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorder Centre, Harvard University, Boston, Massachusetts, USA
| | - Kirsty Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mariana Kruger
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
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21
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Tran YH, Coven SL, Park S, Mendonca EA. Social determinants of health and pediatric cancer survival: A systematic review. Pediatr Blood Cancer 2022; 69:e29546. [PMID: 35107854 PMCID: PMC8957569 DOI: 10.1002/pbc.29546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/07/2022]
Abstract
Despite treatment advancements and improved survival, approximately 1800 children in the United States will die of cancer annually. Survival may depend on nonclinical factors, such as economic stability, neighborhood and built environment, health and health care, social and community context, and education, otherwise known as social determinants of health (SDoH). Extant literature reviews have linked socioeconomic status (SES) and race to disparate outcomes; however, these are not inclusive of all SDoH. Thus, we conducted a systematic review on associations between SDoH and survival in pediatric cancer patients. Of the 854 identified studies, 25 were included in this review. In addition to SES, poverty and insurance coverage were associated with survival. More studies that include other SDoH, such as social and community factors, utilize prospective designs, and conduct analyses with more precise SDoH measures are needed.
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Affiliation(s)
- Yvette H. Tran
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Scott L. Coven
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA,Riley Children’s Hospital, Indianapolis, Indiana, USA
| | - Seho Park
- Department Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Eneida A. Mendonca
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA,Department Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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22
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Wechsler AM, Bragado-Álvarez C, Hernández-Lloreda MJ, Lopes LF, Perina EM. Psychological Adjustment of Children with Cancer: Relapse and Survival Perspectives. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract In Brazil, few studies have investigated the psychological aspects of childhood cancer. The aim of this article was to compare the psychological adjustment of children with cancer from different survival perspectives with that of children without cancer, besides examining potential risk factors. The sample consisted of 179 participants (6-14 years-old) recruited in two Brazilian public hospitals and three schools, and divided in three groups (relapsed, survivors and control). Children answered orally the self-reported Behavior Assessment Scale for Children, the Revised Children’s Manifest Anxiety Scale and Piers-Harris’ Self-Concept Scale. No differences were found between groups regarding school and clinical maladjustment, personal adjustment, emotional symptoms and self-concept. Findings also showed positive associations between psychological maladjustment and gender, younger age, lower household income, single parenthood and lower levels of parental education. Conclusions indicate that children with cancer adapt well to the disease and do not present more psychological problems than controls.
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23
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Beltrami A, Hilliard A, Green AL. Demographic and socioeconomic disparities in pediatric cancer in the United States: Current knowledge, deepening understanding, and expanding intervention. Cancer Epidemiol 2021; 76:102082. [PMID: 34923289 DOI: 10.1016/j.canep.2021.102082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
While survival of pediatric cancer has improved greatly over the past 40 years, demographic and socioeconomic disparities have meant that some groups have not benefitted as much from these advances. We conducted a rapid review to summarize literature on demographic and socioeconomic disparities in outcomes of childhood cancer, starting in 2000. We find that unequal outcomes have been noted for many of these groups across hematologic malignancies, central nervous system tumors, and other solid tumors, although occasional studies have noted absence of disparities for particular at-risk groups and diseases, and gaps in understanding of disparities for some cancer subtypes and groups still exist. These include disparities in duration of overall survival, risk of death, more extensive disease at presentation, and differences/delays in treatment. Black race, Hispanic ethnicity, lack of private insurance, and adolescent/young adult age are most often associated with these poorer outcomes. We then delve into documented and theorized causes of these disparities, including impaired access to care and clinical trials, differences in cancer biology, treatment non-adherence, language barriers, and implicit racial bias. Here, it is clear that socioeconomic factors account for a large proportion of disparities seen, although not all, and that the causes of disparities are complex and interconnected and still need to be better understood. Finally, in an effort to shift emphasis to addressing disparities, we review interventions against disparities that have been studied in childhood cancer patients and other populations, including improving clinical trial representation, communication, health literacy, and family navigation. We suggest ways forward in disparity mitigation toward a goal of achieving equitable cancer outcomes for all children.
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Affiliation(s)
- Alina Beltrami
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Alexandra Hilliard
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Adam L Green
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO, United States.
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24
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Lee BM, Jecker NS, Marron JM, Rosenberg AR. Striving for equity: Patient prioritization during a critical cancer drug shortage. Pediatr Blood Cancer 2021; 68:e29280. [PMID: 34357696 DOI: 10.1002/pbc.29280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Brittany M Lee
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Nancy S Jecker
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA.,Fulbright U.S. Scholar Program, University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Jonathan M Marron
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
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25
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Pérez-Ardanaz B, Peláez-Cantero MJ, González-Cano-Caballero M, Gutiérrez-Rodríguez L, Gómez-González AJ, Lupiáñez-Pérez I, Morales-Asencio JM, Canca-Sánchez JC. Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study. CHILDREN 2021; 8:children8110973. [PMID: 34828686 PMCID: PMC8624513 DOI: 10.3390/children8110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | | | | | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | - Alberto José Gómez-González
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | - Inmaculada Lupiáñez-Pérez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-833
| | - José Carlos Canca-Sánchez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
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26
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Umaretiya PJ, Revette A, Seo A, Flamand Y, Ilcisin L, Zheng DJ, Bhatia S, Wolfe J, Bona K. PediCARE: Development of a poverty-targeted intervention for pediatric cancer. Pediatr Blood Cancer 2021; 68:e29195. [PMID: 34190405 PMCID: PMC8384686 DOI: 10.1002/pbc.29195] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poverty is associated with inferior psychosocial outcomes, higher rates of relapse, and decreased overall survival in children with cancer. Despite this, there are few evidence-based, poverty-targeted interventions and none specific to pediatric oncology. To address this gap, we developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention, a household material hardship (HMH) targeted intervention providing transportation and groceries to pediatric oncology families. METHODS This was a single-arm pilot study conducted at a single, large, tertiary pediatric cancer center. Newly diagnosed patients with HMH-exposure were directly assigned to receive PediCARE for a total of three months. Quantitative and qualitative approaches were used to evaluate its acceptability and to rapidly refine the intervention. RESULTS Nine families (100% of those approached) consented to enrollment with no attrition over the three-month study period. Families were highly satisfied with the intervention and recommended participation to others. All of the families utilized the grocery delivery component of PediCARE, and seven utilized the transportation component. Qualitative participant feedback was used to rapidly refine the intervention including logistics of intervention delivery, and dose of intervention components. CONCLUSION PediCARE, a poverty-targeted intervention, was highly acceptable to pediatric oncology families. The intervention was refined in real-time utilizing quantitative and qualitative feedback. Next steps include intervention evaluation in a randomized, controlled feasibility study.
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Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Anna Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Seo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA,Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, MA
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27
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Lyon ME, Cheng YI, Needle J, Friebert S, Baker JN, Jiang J, Wang J. The intersectionality of gender and poverty on symptom suffering among adolescents with cancer. Pediatr Blood Cancer 2021; 68:e29144. [PMID: 34061435 PMCID: PMC8406702 DOI: 10.1002/pbc.29144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine if the intersectionality of gender and poverty is associated with health disparities among adolescents with cancer. We hypothesized unobserved latent classes of patients exist with respect to cancer-related symptoms; and class classification varies by gender-poverty combinations. PROCEDURE Cross-sectional data were collected among adolescents with cancer and families (N = 126 dyads) at four tertiary pediatric hospitals. Adolescents were aged 14-21 years, English speaking, cancer diagnosis, not developmentally delayed, psychotic, homicidal, suicidal, or severely depressed. Latent class analysis and multinomial logit models were used for analysis. Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures, Short forms, evaluated anxiety, depressive symptoms, pain interference, and fatigue. Family-reported household income used 2016 Federal Poverty Level (FPL) guidelines. RESULTS Three distinct groups of patients were identified using PROMIS symptom patterns: High Distress-25%; High Physical/Low Psychological Distress-14%; and Low Distress-62%. Female adolescents living in households with incomes at or below the 2016 FPL had 30 times the odds of being classified in the High Distress class (higher probabilities of experiencing anxiety, depressive symptoms, pain interference, and fatigue) compared to those in the High Physical/Low Psychological Distress class (female and poverty: AOR = 30.27, 95% CI 1.23, 735.10), and this was statistically significant (β = 3.41, 95% CI 0.21, 6.60; p = .04) but not compared to those in Low Distress. CONCLUSION Adolescent females with cancer with households in poverty had significantly greater odds of experiencing high symptom distress, compared to those with high physical but low psychological distress. More comprehensive screening and intervention, as needed, may decrease disparities.
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Affiliation(s)
- Maureen E. Lyon
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, District of Columbia, USA
- Center for Translational Research/Children’s National Research Institute, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
- RELI Group, Inc., Baltimore, Maryland, USA
| | - Jennifer Needle
- Department of Pediatrics and Center for Bioethics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio, USA
| | - Justin N. Baker
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jiji Jiang
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jichuan Wang
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
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Santacroce SJ, Killela MK, Kamkhoad D, Leckey JA, Hubbard G. He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems. Pediatr Blood Cancer 2021; 68:e29080. [PMID: 33894050 PMCID: PMC10440629 DOI: 10.1002/pbc.29080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family. PROCEDURE Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n = 417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study. RESULTS Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden. CONCLUSION Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.
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Affiliation(s)
- Sheila Judge Santacroce
- School of Nursing, The University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
| | - Mary K. Killela
- School of Nursing, The University of North Carolina at Chapel Hill
| | | | - Jill A. Leckey
- School of Nursing, The University of North Carolina at Chapel Hill
| | - Grace Hubbard
- School of Nursing, The University of North Carolina at Chapel Hill
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29
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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30
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Savage B, Cole PD, Lin H. Racial and Economic Differences in the Risk of Hyperglycemia in Children Hospitalized With Acute Lymphoblastic Leukemia. J Pediatr Oncol Nurs 2021; 38:277-284. [PMID: 33949234 DOI: 10.1177/10434542211011040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The underlying mechanism of hyperglycemia in children with acute lymphoblastic leukemia (ALL) is insulin resistance. Although race and economic status have been linked to increased insulin resistance in children, these have not been explored as predictors of hyperglycemia in children with ALL. The objective of this study was to analyze race and income as predictors of hyperglycemia in a diverse sample of children hospitalized with ALL in the United States in the year 2016. Methods: We performed a secondary analysis of 18,077 hospitalizations of White, Black, and Hispanic children under the age of 21 years with ALL contained in a nationally representative database. Multilevel binary logistic regression models were constructed to estimate the relationships between race, median household income, age, sex, and obesity and the odds of hyperglycemia in hospitalized children with ALL. Results: Hyperglycemia occurred during 5.3% of the hospitalizations. Black children were 37% more likely to develop hyperglycemia than White children. The risk for hyperglycemia did not differ between Hispanic and White children. Residing in areas where annual median income was below $54,000 was associated with 1.4-fold increased odds of hyperglycemia, compared to the wealthiest areas. Older children, females, and those diagnosed with obesity were also at increased risk for hyperglycemia. Discussion: An association has been found between treatment-induced hyperglycemia and increased mortality. For this reason, the racial and economic differences in the risk for hyperglycemia identified in this study deserve further consideration.
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Affiliation(s)
- Beth Savage
- Division of Nursing Science, 16118Rutgers School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Peter D Cole
- Division of Pediatric Hematology/Oncology, 145249Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Haiqun Lin
- Division of Nursing Science, 16118Rutgers School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
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31
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Wimberly CE, Towry L, Caudill C, Johnston EE, Walsh KM. Impacts of COVID-19 on caregivers of childhood cancer survivors. Pediatr Blood Cancer 2021; 68:e28943. [PMID: 33565259 PMCID: PMC7995053 DOI: 10.1002/pbc.28943] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE We sought to assess the impact of disruptions due to coronavirus disease 2019 (COVID-19) on caregivers of childhood cancer survivors. METHODS A 13-question survey containing multiple-choice, Likert-type, and free-text questions on experiences, behaviors, and attitudes during the COVID-19 outbreak was sent to childhood cancer caregivers and completed between April 13 and May 17, 2020. Ordered logistic regression was used to investigate relationships between demographics, COVID-related experiences, and caregiver well-being. RESULTS Caregivers from 321 unique families completed the survey, including 175 with children under active surveillance/follow-up care and 146 with children no longer receiving oncology care. Overall, caregivers expressed exceptional resiliency, highlighting commonalities between caring for a child with cancer and adopting COVID-19 prophylactic measures. However, respondents reported delayed/canceled appointments (50%) and delayed/canceled imaging (19%). Eleven percent of caregivers reported struggling to pay for basic needs, which was associated with greater disruption to daily life, greater feelings of anxiety, poorer sleep, and less access to social support (p < .05). Caregivers who were self-isolating reported greater feelings of anxiety and poorer sleep (p < .05). Respondents who expressed confidence in the government response to COVID-19 reported less disruption to their daily life, decreased feelings of depression and anxiety, better sleep, and greater hopefulness (p < .001) CONCLUSIONS: Caregivers are experiencing changes to medical care, financial disruptions, and emotional distress due to COVID-19. To better serve caregivers and medically at-risk children, clinicians must evaluate financial toxicity and feelings of isolation in families affected by childhood cancer, and work to provide reliable information on how COVID-19 may differentially impact their children.
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Affiliation(s)
- Courtney E. Wimberly
- Division of Neuro‐Epidemiology, Department of NeurosurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Lisa Towry
- Alex's Lemonade Stand FoundationBala CynwydPennsylvaniaUSA
| | - Caroline Caudill
- Institute for Cancer Survivorship and OutcomesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Emily E. Johnston
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kyle M. Walsh
- Division of Neuro‐Epidemiology, Department of NeurosurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Duke Cancer InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Children's Health and Discovery Institute, Department of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
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32
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Childhood Acute Leukemias in Developing Nations: Successes and Challenges. Curr Oncol Rep 2021; 23:56. [PMID: 33755790 DOI: 10.1007/s11912-021-01043-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Acute leukemias represent a tremendous threat to public health around the globe and the main cause of death due to disease in scholar age children from developing nations. Here, we review their current status in Mexico, as a paradigm of study, and the major challenges to control systemic diseases like childhood cancer. RECENT FINDINGS A unique molecular epidemiology, late/low precision diagnosis, limited access to treatment, toxicity associated with therapy, continuous exposure to environmental risk factors, and the high frequency of early relapses are some of the factors cooperating to low rates of survival in low-to-medium-income countries. Deliberative dialogues and exhaustive programs have emerged as promising means of advancing evidence-informed policy, by providing a structured forum for key stakeholders to integrate scientific and pragmatic knowledge about complex health concerns. A system-wide strategy based on the comprehensive leukemia identity is essential for a meaningful decline in early childhood mortality.
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33
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Wolfson JA. Poverty and Survival in Childhood Cancer: A Framework to Move Toward Systemic Change. J Natl Cancer Inst 2021; 113:227-230. [PMID: 33227815 DOI: 10.1093/jnci/djaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Julie Anna Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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34
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Bona K, Brazauskas R, He N, Lehmann L, Abdel-Azim H, Ahmed IA, Al-Homsi AS, Aljurf M, Arnold SD, Badawy SM, Battiwalla M, Beattie S, Bhatt NS, Dalal J, Dandoy CE, Diaz MA, Frangoul HA, Freytes CO, Ganguly S, George B, Gomez-Almaguer D, Hahn T, Kamble RT, Knight JM, LeMaistre CF, Law J, Lazarus HM, Majhail NS, Olsson RF, Preussler J, Savani BN, Schears R, Seo S, Sharma A, Srivastava A, Steinberg A, Szwajcer D, Wirk B, Yoshimi A, Khera N, Wood WA, Hashmi S, Duncan CN, Saber W. Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis. Blood 2021; 137:556-568. [PMID: 33104215 PMCID: PMC7845011 DOI: 10.1182/blood.2020006252] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age ≤18 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (≥20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.
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Affiliation(s)
- Kira Bona
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Naya He
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Staci D Arnold
- Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Neel S Bhatt
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jignesh Dalal
- Rainbow Babies and Children's Hospital, Cleveland Case Western Reserve School of Medicine, Cleveland, OH
| | - Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Haydar A Frangoul
- Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN
| | | | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - David Gomez-Almaguer
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Theresa Hahn
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Jennifer M Knight
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jason Law
- Division of Pediatric Hematology/Oncology, Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Jaime Preussler
- CIBMTR, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Raquel Schears
- Department of Emergency Medicine, University of Central Florida, Orlando, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Alok Srivastava
- Centre for Stem Cell Research, Christian Medical College, Vellore, India
| | - Amir Steinberg
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY
| | - David Szwajcer
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, MN; and
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Christine N Duncan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
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McLean L, Hong W, McLachlan SA. Financial toxicity in patients with cancer attending a public Australian tertiary hospital: A pilot study. Asia Pac J Clin Oncol 2020; 17:245-252. [PMID: 32894819 DOI: 10.1111/ajco.13448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023]
Abstract
AIM As therapeutic options for cancer evolve and become more complex, the concept of financial toxicity has emerged. The comprehensive score for financial toxicity (COST) and iMTA Productivity Cost questionnaires (iPCQ) represent two tools developed to measure the concept. The aim of this pilot study was to review the impact of financial toxicity in patients with cancer in an Australian public setting where there is a universal health care model. METHODS This pilot study utilized an exploratory, cross-sectional design in a single Australian large inner-city tertiary center. After providing written consent eligible patients, in an ambulatory setting, completed four self-reporting questionnaires, which were written in English (basic demographics, COST, iPCQ and the European Organization Research Treatment of Cancer Quality of Life Questionnaire-C30 [EORTC-QLQ-C30]). RESULTS Of 97 patients approached, 66 consented to participate. The median age was 63.5 years. Fifty-five percent were female. Fifty-three completed COST questionnaires. The median score for financial toxicity was 18 (range 1-42). Higher COST scores indicated greater financial concerns and were associated with poorer quality of life (P = .004). This was maintained after adjusting for confounders (age, gender, regional postcode.) Univariate analysis demonstrated younger age was associated with higher COST scores (P < .001), while gender (P = .243) and geographical location (P = .243) were not. CONCLUSIONS In a cohort of patients receiving systemic cancer therapy in an Australian public setting, financial toxicity was associated with poorer quality of life. Despite a universal health-model, the COST questionnaire identified a substantial proportion of patients who experienced financial toxicity.
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Affiliation(s)
- Luke McLean
- Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Australia
| | - Wei Hong
- Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Australia
| | - Sue-Anne McLachlan
- Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Australia.,SVHM Department of Medicine, University of Melbourne, Melbourne, Australia
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36
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Schraw JM, Peckham-Gregory EC, Rabin KR, Scheurer ME, Lupo PJ, Oluyomi A. Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28525. [PMID: 32573920 DOI: 10.1002/pbc.28525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have evaluated social determinants of outcomes disparities for children with acute lymphoblastic leukemia (ALL). We investigated the association of area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, with overall survival (OS) among children and adolescents with ALL. PROCEDURE We obtained demographic and clinical data, geocoded addresses at diagnosis, and vital status on all Texas children diagnosed with ALL from 1995 to 2011 (N = 4104). Using the US Census Bureau 2010 geography, we computed ADI scores for all census tracts in Texas and grouped the tracts into quartiles: least, third-most, second-most, and most disadvantaged. We mapped children to ADI quartiles based on residence at diagnosis, and estimated OS using Cox regression adjusting for sex, race/ethnicity, age, and metropolitan/nonmetropolitan residence. RESULTS Five-year OS ranged from 89% (95% confidence interval [CI] 87-91%) for children in the least disadvantaged tracts to 79% (95% CI 76-81%) for children in the most disadvantaged tracts (P = 4E-7). An elevated hazard ratio (HR) for death was observed for children in the most disadvantaged tracts (HR 1.57, 95% CI 1.23-2.00), and trends toward increased mortality were observed in the third-most and second-most disadvantaged tracts (HR 1.23, 95% CI 0.97-1.57 and HR 1.27, 95% CI 0.99-1.62, respectively). In stratified analyses, area disadvantage was more strongly associated with OS in males than females. CONCLUSIONS Neighborhood socioeconomic disadvantage is associated with inferior OS in this analysis of over 4100 children with ALL, highlighting the substantial contributions of social-environmental factors to childhood cancer survival. This association was stronger in males than females.
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Affiliation(s)
- Jeremy M Schraw
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Erin C Peckham-Gregory
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Karen R Rabin
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Michael E Scheurer
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Philip J Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Abiodun Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Santacroce SJ, Kneipp SM. A Conceptual Model of Financial Toxicity in Pediatric Oncology. J Pediatr Oncol Nurs 2020; 36:6-16. [PMID: 30798687 DOI: 10.1177/1043454218810137] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this article is to explicate a conceptual framework for financial toxicity in pediatric oncology to guide nursing practice and research. The framework is based on one for financial outcomes of severe illness attributed to Scott Ramsey and adapted by the National Cancer Institute to describe relationships between preexisting factors, a cancer diagnosis, financial distress, and health outcomes for adult cancer patients and survivors. The adaption for pediatric oncology was informed by the results of a systematic scoping review to identify advances and gaps in the recent literature about the personal costs of illness to parents in the pediatric oncology context. The conceptual model for pediatric oncology indicates that existing and dynamic parent and family factors, other risk and protective factors, the child's diagnosis and treatment, and treatment-related financial costs can affect parent financial coping behaviors and parent health and family financial outcomes, all of which may affect child outcomes. Additionally, nursing's historic emphasis on holistic care, quality of life, and health determinants justify attention to financial toxicity as a nursing role. Therefore, pediatric oncology nurses must be sensitive to financial toxicity and related risk factors, become comfortable communicating about treatment-related financial costs and financial distress with parents and other health professionals, and collaborate in efforts that draw on the expertise of multiple stakeholders to identify potential or actual financial toxicity in parents and mitigate its impact on childhood cancer health outcomes through direct care, referral, research, quality improvement, and health advocacy.
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Affiliation(s)
| | - Shawn M Kneipp
- 1 The University of North Carolina at Chapel Hill, NC, USA
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Aggarwal P, Singh TB, Gupta V. Impact of Sociodemographic Factors and Nutrition on the Duration of Induction Phase of Chemotherapy in children with Acute lymphoblastic leukemia: A Tertiary Center Experience from North India. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_226_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Immunocompromised patients are at increased risk of infections, especially those living in poor hygienic conditions. Aims and Objectives: This study aims to assess the effect of weight, immunization status of the child at the start of treatment along with the socioeconomic status (SES), and demographic parameters, i.e., type of house, sanitary facility (SF), and source of drinking water on the duration of induction phase of chemotherapy (delayed if the patient received chemotherapy for >29 days). Materials and Methods: 110 pediatric acute lymphoblastic leukemia patients aged 1.5–14 years who underwent induction of remission from June 2015 to February 2018 were included. The immunization status and weight of the child were recorded at the start of treatment. SES was assessed using modified Kuppuswami scale and a questionnaire was used to determine various sociodemographic parameters. Results: The patients not immunized as per age (P = 0.000) and having poor demographic parameters, i.e., mud house (P = 0.000), absence of SF (P = 0.013), and nonfiltered drinking water (P = 0.005), had significant delay. The duration of induction phase of chemotherapy was not delayed with poor SES (P = 0.832). Although the duration was delayed in patients with weight ≥10 percentile, it was not statistically significant (P = 0.079). On analyzing the three demographic parameters together as Water-Sanitary Facility-Housing (WaSH) Score (0–4), the duration was also significantly delayed if the patients had WaSH score <2. Conclusion: The duration of induction phase of chemotherapy is delayed with inadequate immunization status and poor hygiene of the child.
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Affiliation(s)
- Priyanka Aggarwal
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - TB Singh
- Department of Community Medicine, Division of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vineeta Gupta
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Totadri S, Trehan A, Kaur A, Bansal D. Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia. Indian J Med Res 2019; 149:26-33. [PMID: 31115371 PMCID: PMC6507537 DOI: 10.4103/ijmr.ijmr_579_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients’ database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata (P=0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent (P=0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P=0.015); 1.98 (P=0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Appinderjit Kaur
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Impact of Race and Socioeconomic Status on Psychologic Outcomes in Childhood Cancer Patients and Caregivers. J Pediatr Hematol Oncol 2019; 41:433-437. [PMID: 30629003 DOI: 10.1097/mph.0000000000001405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complex relationships between race and socioeconomic status have a poorly understood influence on psychologic outcomes in pediatric oncology. The Family Symptom Inventory was used to assess symptoms of depression and anxiety in pediatric patients with cancer and their caregivers. Separate hierarchical linear regression models examined the relationship between demographic variables, cancer characteristics, socioeconomic status, and access to care and patient or caregiver depression/anxiety. Participants included 196 pediatric patients with cancer (mean age, 11.21 y; 49% African American) and their caregivers. On average, caregivers reported low levels of depression/anxiety. Symptoms of depression and anxiety in patients were correlated with poorer mental health in caregivers (r=0.62; P<0.01). Self-reported financial difficulty (β=0.49; P<0.001) and brain cancer diagnosis for their child (β=0.42; P=0.008) were significantly associated with depression and anxiety in caregivers. Analysis did not reveal significant associations between race, household income, or access to care and patient or caregiver depression/anxiety. Perception of financial hardship can adversely impact mental health in caregivers of children with cancer. Psychosocial assessment and interventions may be especially important for caregivers of patients with brain tumors and caregivers who report feeling financial difficulty.
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Whittle S, Lopez M, Russell H. Payer and race/ethnicity influence length and cost of childhood cancer hospitalizations. Pediatr Blood Cancer 2019; 66:e27739. [PMID: 30989762 PMCID: PMC7057732 DOI: 10.1002/pbc.27739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/15/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Health disparities related to race, ethnicity, socioeconomic status, and insurance status impact quality, access, and health outcomes for children. Medicaid is a proxy for poverty and restricted access to health care. The goal of this study was to determine if there are discrepancies in the length and cost of hospitalizations between admissions covered by Medicaid or commercial insurance for pediatric patients with cancer. METHODS Childhood cancer-related admissions were identified from the 2012 Kids Inpatient Database (KID) using the International Classification of Diseases, Ninth revision. Length of hospitalization and cost of hospitalization were compared among hospitalizations paid by Medicaid or commercial insurance. Total admission charges were converted to costs using cost-to-charge ratios, and survey weighting methods were used for all analyses. Linear multiple regression models for both length of hospitalization and cost were developed to include patient-level factors (race, sex, age, diagnosis, reason for admission). RESULTS In 2012, there were 104 597 childhood cancer-related admissions. Hospitalizations paid by Medicaid were significantly longer than those paid by commercial insurance. Hispanic ethnicity was associated with higher cost of hospitalization regardless of payer, and black race was associated with higher costs within the Medicaid population. CONCLUSIONS This analysis identifies differences in healthcare utilization for pediatric cancer-related admissions paid for by Medicaid compared with commercial insurance. Prolonged hospitalizations and increased costs create burdens on children and their families, medical delivery systems, and third-party payers. Further exploration into the causes of these disparities is warranted.
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Affiliation(s)
- Sarah Whittle
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Michelle Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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Hentea C, Downs SM, Tucker Edmonds B, Vik T, Wiehe SE, Cheng ER. Impact of socioeconomic markers on parents' retention of pediatric oncology home care education: A pilot study. Pediatr Blood Cancer 2019; 66:e27624. [PMID: 30693652 DOI: 10.1002/pbc.27624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022]
Abstract
Little is known about the extent to which parents retain the education on how to manage home medical emergencies. We sought to describe retention of pediatric oncology home care education (POHCE) in a cohort of 24 parents of newly diagnosed children with cancer and investigate sociodemographic disparities in this retention. We measured retention using a vignette-based survey instrument. The mean score was 4 (range 0-6, SD = 1.6) and parents with high school only education and those with limited cancer health literacy scored lowest (2.5 and 2.8, respectively). Future POHCE interventions can focus on parents' literacy and education levels as predictors to tailor alternative education strategies.
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Affiliation(s)
- Cristiana Hentea
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Stephen M Downs
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
| | - Brownsyne Tucker Edmonds
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
| | - Terry Vik
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
| | - Erika R Cheng
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
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Li Y, Newton JG, Getz KD, Huang YS, Seif AE, Fisher BT, Aplenc R, Winestone LE. Comparable on-therapy mortality and supportive care requirements in Black and White patients following initial induction for pediatric acute myeloid leukemia. Pediatr Blood Cancer 2019; 66:e27583. [PMID: 30585685 PMCID: PMC6386601 DOI: 10.1002/pbc.27583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/23/2018] [Accepted: 11/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Black patients with acute myeloid leukemia (AML) are more likely to present with high acuity and consequently experience higher rates of induction mortality than white patients. Given the consistently identified racial disparities in overall survival (OS) among patients with AML, we aimed to evaluate whether there were sustained on-therapy racial differences in inpatient mortality, intensive care unit (ICU) requirements, or supportive care beyond initial induction. PROCEDURE Within a retrospective cohort of 1239 children diagnosed with AML between 2004 and 2014 in the Pediatric Health Information System (PHIS) database who survived their initial course of induction chemotherapy, we compared on-therapy inpatient mortality, ICU-level care requirements, treatment course duration, cumulative length of hospital stay (LOS), and resource utilization after induction I by race. RESULTS Over the period from the start of induction II through completion of frontline chemotherapy, there were no significant differences in mortality (adjusted odds ratios [OR], 1.01; 95% confidence intervals [CI], 0.41-2.48), ICU-level care requirements (adjusted OR, 0.93; 95% CI, 0.69-1.26), LOS (adjusted mean difference, 3.2 days; 95% CI, -2.3-9.6), or supportive care resource utilization for black patients relative to white patients. Course-specific analyses also demonstrated no differences by race. CONCLUSION Although black patients have higher acuity at presentation and higher induction mortality, such disparities do not persist over subsequent frontline chemotherapy treatment. This finding allows interventions aimed at reducing disparities to be directed at presentation and induction.
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Affiliation(s)
- Yimei Li
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joanna G. Newton
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA
| | - Kelly D. Getz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yuan-Shung Huang
- Healthcare Analytics Unit, Department of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alix E. Seif
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Brian T. Fisher
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard Aplenc
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lena E. Winestone
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA,Division of Allergy, Immunology & BMT, Department of Pediatrics, University of California – San Francisco, San Francisco, CA
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Zheng DJ, Shyr D, Ma C, Muriel A, Wolfe J, Bona K. Feasibility of systematic poverty screening in a pediatric oncology referral center. Pediatr Blood Cancer 2018; 65:e27380. [PMID: 30069999 PMCID: PMC6193823 DOI: 10.1002/pbc.27380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Based on the strong link between poverty and child health outcomes, both the American Academy of Pediatrics (AAP) and national pediatric oncology associations have advocated for routine clinical poverty screening. Systematic implementation of this recommendation in pediatric oncology is not yet standard, and feasibility data are needed. We report the feasibility of routine poverty screening in a pediatric oncology referral center and baseline poverty characteristics of this population. METHODS From 2013 to 2017, 448 families with newly diagnosed pediatric cancer at Dana-Farber/Boston Children's Cancer and Blood Disorders Center were offered the Psychosocial Assessment Tool 2.0 (PAT) as part of routine care. The PAT includes a two-item screen for household material hardship (HMH). All families were asked about annual household income by a resource specialist. Data were abstracted with sociodemographic and child/disease characteristics. Descriptive statistics are reported. RESULTS Four hundred and thirteen families completed the PAT (response rate 92%), of whom 394 (95%) completed specific questions assessing for HMH. Ninety-four percent of families who met with a resource specialist disclosed their annual household income. One quarter (27%) of families was ≤200% federal poverty level at diagnosis, and 44% of families endorsed at least one domain of HMH. The most frequent domains of HMH included housing (24%), utilities (20%), and transportation (20%). CONCLUSIONS Systematic poverty screening per AAP and pediatric oncology psychosocial standards of care is feasible in routine cancer care. There is a high baseline incidence (44%) of HMH in at least one domain in families with newly diagnosed pediatric cancer who may benefit from early identification and resource intervention.
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Affiliation(s)
- Daniel J. Zheng
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Derek Shyr
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Clement Ma
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Anna Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Joanne Wolfe
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Kira Bona
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, MA
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Marcil LE, Zuckerman BS. Child Poverty: New Opportunities for Pediatricians. J Pediatr 2018; 202:10-12. [PMID: 30172434 DOI: 10.1016/j.jpeds.2018.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Lucy E Marcil
- Department of Pediatrics Boston Medical Center Boston University School of Medicine Boston, Massachusetts.
| | - Barry S Zuckerman
- Department of Pediatrics Boston Medical Center Boston University School of Medicine Boston, Massachusetts
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Wolfson JA, Richman JS, Sun CL, Landier W, Leung K, Smith EP, O'Donnell M, Bhatia S. Causes of Inferior Outcome in Adolescents and Young Adults with Acute Lymphoblastic Leukemia: Across Oncology Services and Regardless of Clinical Trial Enrollment. Cancer Epidemiol Biomarkers Prev 2018; 27:1133-1141. [PMID: 30262597 DOI: 10.1158/1055-9965.epi-18-0430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/29/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Adolescents and young adults (AYA: 15-39 years) with acute lymphoblastic leukemia (ALL) have inferior survival when compared with children (1-14 years). An approach is lacking that includes both patients enrolled and not enrolled in clinical trials, and includes the contribution of health care delivery, treatment, and clinical prognosticators.Methods: We assembled a retrospective cohort of ALL patients diagnosed between 1-39 years (AYA: n = 93; child: n = 91) and treated at a single institution between 1990 and 2010, irrespective of clinical trial enrollment. We modeled relapse risk (i) during therapy and (ii) after completing therapy.Results: On-therapy relapse: AYA experienced an increased risk of on-therapy relapse versus children (HR, 10.5; P = 0.004). In multivariable analysis restricted to AYA, independent predictors of relapse included lack of clinical trial enrollment (HR, 2.6, P = 0.04) and nonwhite race/ethnicity (HR, 2.2; P = 0.05). Relapse after completing therapy: When compared with children, AYA experienced an increased risk of relapse after completing therapy (HR, 7.7; P < 0.001). In multivariable analysis restricted to AYA, longer therapy (months of maintenance: HR, 0.7; P < 0.001; months of consolidation: HR, 0.8; P = 0.03) protected against relapse.Conclusions: Among AYA, aspects of health care delivery (clinical trial enrollment, nonwhite race/ethnicity) are associated with relapse during therapy, and aspects of treatment (shorter duration of maintenance and consolidation) are associated with relapse after completing therapy.Impact: These findings highlight the importance of clinical trial enrollment and therapy duration (maintenance, consolidation) in ensuring durable remissions in AYA ALL. Future studies encompassing health care delivery, treatment, and biology are needed. Cancer Epidemiol Biomarkers Prev; 27(10); 1133-41. ©2018 AACR.
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Affiliation(s)
- Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua S Richman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Can-Lan Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Leung
- Department of Population Sciences, City of Hope, Duarte, California
| | - Eileen P Smith
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Margaret O'Donnell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Ilowite MF, Al-Sayegh H, Ma C, Dussel V, Rosenberg AR, Feudtner C, Kang TI, Wolfe J, Bona K. The relationship between household income and patient-reported symptom distress and quality of life in children with advanced cancer: A report from the PediQUEST study. Cancer 2018; 124:3934-3941. [PMID: 30216416 DOI: 10.1002/cncr.31668] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/15/2018] [Accepted: 06/11/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Children with advanced cancer experience high symptom distress, which negatively impacts their health-related quality of life (HRQOL). To the authors' knowledge, the relationship between income and symptom distress and HRQOL is not well described. METHODS The Pediatric Quality of Life and Symptoms Technology (PediQUEST) multisite clinical trial evaluated an electronic patient-reported outcome system to describe symptom distress and HRQOL in children with advanced cancer via repeated surveys. The authors performed a secondary analysis of PediQUEST data for those children with available parent-reported household income (dichotomized at 200% of the Federal Poverty Level and categorized as low income [<$50,000/year] or high income [≥$50,000/year]). The prevalence of the 5 most commonly reported physical and psychological symptoms was compared between groups. Multivariable generalized estimating equation models were used to test the association between household income and symptom distress and HRQOL. RESULTS A total of 78 children were included in the analyses: 56 (72%) in the high-income group and 22 (28%) in the low-income group. Low-income children were more likely to report pain than high-income children (64% vs 42%; P=.02). In multivariable models, children from low-income families demonstrated a uniform trend toward higher total (βlow-high =3.1; 95% confidence interval [95% CI], -0.08 to 6.2 [P=.06]), physical (β=3.8; 95% CI, -0.4 to 8.0 [P=.09]), and psychological (β=3.46; 95% CI, -1.91 to 8.84 [P=.21]) symptom distress compared with children from high-income families. Low income was associated with a uniform trend toward lower total (β=-7.9; 95% CI, -14.8, to -1.1 [P=.03]), physical (β=-11.2; 95% CI, -21.2 to -1.2 [P=.04]), emotional (β=-5.8; 95% CI, -13.6 to 2.0 [P=.15]), social (β=-2.52; 95% CI, -9.27 to 4.24 [P=.47]), and school (β=-9.8; 95% CI, -17.8 to -1.8 [P=.03]) HRQOL. CONCLUSIONS In this cohort of children with advanced cancer, children from low-income families were found to experience higher symptom burden and worse QOL.
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Affiliation(s)
- Maya F Ilowite
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Clement Ma
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Veronica Dussel
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Chris Feudtner
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tammy I Kang
- Section of Palliative Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
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Abstract
OBJECTIVES To describe pediatric palliative care (PPC) in pediatric oncology, the importance of PPC for pediatric oncology patients, disparities within pediatric palliative oncology, innovative strategies for improving PPC access in underserved populations, and implications for oncology nursing practice. DATA SOURCES Published pediatric oncology and palliative peer-reviewed articles and guidance documents. CONCLUSION Disparities exist within pediatric palliative oncology. There is much work needed to improve the reach and quality of PPC for pediatric oncology patients, especially those from underserved populations. IMPLICATIONS FOR NURSING PRACTICE Nurses serve a critical role in advocating for PPC for seriously ill pediatric cancer patients and their families.
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Zheng DJ, Krull KR, Chen Y, Diller L, Yasui Y, Leisenring W, Brouwers P, Howell R, Lai JS, Balsamo L, Oeffinger KC, Robison LL, Armstrong GT, Kadan-Lottick NS. Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study. Cancer 2018; 124:3220-3230. [PMID: 29888538 DOI: 10.1002/cncr.31379] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P = .003), headstrong behavior (19% vs 13%; P < .001), attention deficits (21% vs 13%; P < .001), peer conflict/social withdrawal (26% vs 17%; P < .001), and antisocial behavior (16% vs 12%; P = .01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P < .001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤ .004). Endocrine disease (P ≤ .004) and peripheral neuropathy (P ≤ .02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Daniel J Zheng
- Yale University School of Medicine, New Haven, Connecticut.,Boston Children's Hospital, Boston, Massachusetts.,Boston Medical Center, Boston, Massachusetts
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Diller
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Pim Brouwers
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Rebecca Howell
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin-Shei Lai
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lyn Balsamo
- Yale University School of Medicine, New Haven, Connecticut.,Yale Comprehensive Cancer Center, New Haven, Connecticut
| | | | | | | | - Nina S Kadan-Lottick
- Yale University School of Medicine, New Haven, Connecticut.,Yale Comprehensive Cancer Center, New Haven, Connecticut
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