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Ennett S, Das A, Burcham M, Fitzgerald R, Boville B, Rajasekaran S, Kortz T, Leimanis‐Laurens ML. Linguistic isolation correlates with length of stay and mortality for pediatric oncology patients in California. Cancer Med 2024; 13:e7371. [PMID: 38967244 PMCID: PMC11224970 DOI: 10.1002/cam4.7371] [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: 12/28/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE To evaluate social drivers of health and how they impact pediatric oncology patients' clinical outcomes during pediatric intensive care unit (PICU) admission via correlation with patient ZIP codes. METHODS Demographic, clinical, and outcome variables from Virtual Pediatric Systems®, LLC for oncology patients (2009-2021) in California PICUs (excluding postoperative) using 3-digit ZIP Codes with social drivers of health variables linguistic isolation, poverty, race/ethnicity, and education abstracted from American Community Survey data for 3-digit ZIP Codes using the Environmental Protection Agency's EJScreen tool. Outcomes of length of stay (LOS), mortality, acuity scores, were compared with social variables. RESULTS Positive correlation between mortality and minority racial groups (Hispanic/Latino) across ZIP Codes (correlation coefficients of 0.45 (95% CI: 0.22-0.64, p < 0.001) in 2017, 0.50 (95% CI: 0.27-0.68, p < 0.001) in 2018, 0.33 (95% CI: 0.07-0.54, p = 0.013) in 2020, and 0.32 (95% CI: 0.06-0.53, p = 0.018) in 2021). Median PICU length of stay significantly correlated with linguistic isolation (coefficient of 0.42 (95% CI: 0.18-0.61, p = 0.001) in 2021 versus -0.41 (95% CI: -0.61 to -0.16, p = 0.002) in 2019), which included PRISMIII (n = 7417). Mixed effects logistic regression model for other constant variables (PRISMIII, cancer type, race/ethnicity, year), random effect of patient, linguistic isolation (percentage as a continuous value) was significantly associated (95% CI: 1.01-1.06; p = 0.02) with mortality; (OR = 1.03). CONCLUSIONS Linguistic isolation was correlated with LOS and mortality, however variable year to year.
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Affiliation(s)
| | - Akansha Das
- Washington & Jefferson CollegeWashingtonPennsylvaniaUSA
| | - Megan Burcham
- Pediatric Hematology Oncology, Helen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Robert Fitzgerald
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Brian Boville
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Surender Rajasekaran
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
- Department of Pediatrics, Division of Critical Care MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Office of Research, Corewell HealthGrand RapidsMichiganUSA
| | - Teresa Kortz
- Department of Pediatrics, Division of Critical Care MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mara L. Leimanis‐Laurens
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
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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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Lind KT, Molina E, Mellies A, Schneider KW, Daley W, Green AL. Early death from childhood cancer: First medical record-level analysis reveals insights on diagnostic timing and cause of death. Cancer Med 2023; 12:20201-20211. [PMID: 37787020 PMCID: PMC10587965 DOI: 10.1002/cam4.6609] [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: 05/11/2023] [Revised: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Approximately 7.5% of pediatric cancer deaths occur in the first 30 days post diagnosis, termed early death (ED). Previous database-level analyses identified increased ED in Black/Hispanic patients, infants, late adolescents, those in poverty, and with specific diagnoses. Socioeconomic and clinical risk factors have never been assessed at the medical record level and are poorly understood. METHODS We completed a retrospective case-control study of oncology patients diagnosed from 1995 to 2016 at Children's Hospital Colorado. The ED group (n = 45) was compared to a non-early death (NED) group surviving >31 days, randomly selected from the same cohort (n = 44). Medical records and death certificates were manually reviewed for sociodemographic and clinical information to identify risk factors for ED. RESULTS We identified increased ED risk in central nervous system (CNS) tumors and, specifically, high-grade glioma and atypical teratoid/rhabdoid tumor. There was prolonged time from symptom onset to seeking care in the ED group (29.4 vs. 9.8 days) with similar time courses to diagnosis thereafter. Cause of death was most commonly from tumor progression in brain/CNS tumors and infection in hematologic malignancies. CONCLUSIONS In this first medical record-level analysis of ED, we identified socioeconomic and clinical risk factors. ED was associated with longer time from first symptoms to presentation, suggesting that delayed presentation may be an addressable risk factor. Many individual patient-level risk factors, including socioeconomic measures and barriers to care, were unable to be assessed through record review, highlighting the need for a prospective study to understand and address childhood cancer ED.
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Affiliation(s)
- Katherine T. Lind
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Elizabeth Molina
- Population Health Shared Resource University of Colorado Cancer CenterAuroraColoradoUSA
| | - Amy Mellies
- Population Health Shared Resource University of Colorado Cancer CenterAuroraColoradoUSA
| | - Kami Wolfe Schneider
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - William Daley
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Adam L. Green
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
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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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5
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Berkman AM, Andersen CR, Cuglievan B, McCall DC, Lupo PJ, Parsons SK, DiNardo CD, Short NJ, Jain N, Kadia TM, Livingston JA, Roth ME. Long-Term Outcomes among Adolescent and Young Adult Survivors of Acute Leukemia: A Surveillance, Epidemiology, and End Results Analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:1176-1184. [PMID: 35553621 DOI: 10.1158/1055-9965.epi-21-1388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a growing population of adolescent and young adult (AYA, age 15-39 years) acute leukemia survivors in whom long-term mortality outcomes are largely unknown. METHODS The current study utilized the Surveillance, Epidemiology, and End Results (SEER) registry to assess long-term outcomes of AYA acute leukemia 5-year survivors. The impact of diagnosis age, sex, race/ethnicity, socioeconomic status, and decade of diagnosis on long-term survival were assessed utilizing an accelerated failure time model. RESULTS A total of 1,938 AYA acute lymphoblastic leukemia (ALL) and 2,350 AYA acute myeloid leukemia (AML) survivors diagnosed between 1980 and 2009 were included with a median follow-up of 12.3 and 12.7 years, respectively. Ten-year survival for ALL and AML survivors was 87% and 89%, respectively, and 99% for the general population. Survival for AYA leukemia survivors remained below that of the age-adjusted general population at up to 30 years of follow-up. Primary cancer mortality was the most common cause of death in early survivorship with noncancer causes of death becoming more prevalent in later decades of follow-up. Male AML survivors had significantly worse survival than females (survival time ratio: 0.61, 95% confidence interval: 0.45-0.82). CONCLUSIONS AYA leukemia survivors have higher mortality rates than the general population that persist for decades after diagnosis. IMPACT While there have been improvements in late mortality, long-term survival for AYA leukemia survivors remains below that of the general population. Studies investigating risk factors for mortality and disparities in late effects among long-term AYA leukemia survivors are needed.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C McCall
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Courtney D DiNardo
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicholas J Short
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nitin Jain
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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6
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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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Zhan C, Wu Z, Yang L, Yu L, Deng J, Luk K, Duan C, Zhang L. Disparities in economic burden for children with leukemia insured by resident basic medical insurance: evidence from real-world data 2015–2019 in Guangdong, China. BMC Health Serv Res 2022; 22:229. [PMID: 35183172 PMCID: PMC8858506 DOI: 10.1186/s12913-022-07564-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pediatric leukemia is the most prevalent childhood cancer in China and incurs heavy economic burden to patients without sufficient insurance protection. Although all Chinese children are obliged to enroll in the national insurance scheme, “Resident Basic Medical Insurance (RBMI)”, the protection may vary among patient subgroups. This study is designed to measure the disparities in economic burden for patients with leukemia under RBMI protection and explore the influencing factors. Methods The included patients were aged ≤ 15 and diagnosed with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML, with/without transplantation). They all completed treatment course consecutively in Nanfang Hospital and Zhujiang Hospital from Jan.1, 2015, to Dec.30, 2019, in Guangzhou, China. Their inpatient treatment and insurance settlement data were drawn from the Hospital Information System (HIS) and Insurance Settlement System (ISS). A total of 765 consecutive patients and 14,477 inpatient medical records were included and analyzed. Their insurance status (6 subtypes), economic burden [total cost, out-of-pocket cost (OOP), reimbursement, reimbursement rate (RR)], and cost structures (operation/procedure, blood products, drug, simple treatment) were calculated respectively. Non-normally distributed costs were reported as the median and interquartile range (IQR). Wilcoxon test was used for univariate tests and generalized linear model with log link was used to explore the influencing factors. Results The insured patients who were treated in the location of insurance with instant reimbursement reported the highest total cost and reimbursement, while those who seek medical care cross-province with no instant reimbursement reported the lowest total cost and highest OOP payment. In terms of annual change, the total cost of children with leukemia decreased from 2015–2019 with stably increasing reimbursement rate. Blood products and drugs were the major components of total cost, but they decreased annually. Patients who received transplantation and treated across provinces were with a higher economic burden. Conclusion The economic burden for children with leukemia decreased overtime under the protection of RBMI, but disparities exist among subtypes. The payer-provider contract on instant reimbursement and drug cost control are effective measures for insurance administrators to curb the economic burdens of pediatric leukemia treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07564-8.
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Schraw JM, Peckham-Gregory EC, Hughes AE, Scheurer ME, Pruitt SL, Lupo PJ. Residence in a Hispanic Enclave Is Associated with Inferior Overall Survival among Children with Acute Lymphoblastic Leukemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9273. [PMID: 34501862 PMCID: PMC8430860 DOI: 10.3390/ijerph18179273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023]
Abstract
Hispanic children with acute lymphoblastic leukemia (ALL) experience poorer overall survival (OS) than non-Hispanic White children; however, few studies have investigated the social determinants of this disparity. In Texas, many Hispanic individuals reside in ethnic enclaves-areas with high concentrations of immigrants, ethnic-specific businesses, and language isolation, which are often socioeconomically deprived. We determined whether enclave residence was associated with ALL survival, overall and among Hispanic children. We computed Hispanic enclave index scores for Texas census tracts, and classified children (N = 4083) as residing in enclaves if their residential tracts scored in the highest statewide quintile. We used Cox regression to evaluate the association between enclave residence and OS. Five-year OS was 78.6% for children in enclaves, and 77.8% for Hispanic children in enclaves, both significantly lower (p < 0.05) than the 85.8% observed among children not in enclaves. Children in enclaves had increased risk of death (hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.01-1.49) after adjustment for sex, age at diagnosis, year of diagnosis, metropolitan residence and neighborhood socioeconomic deprivation and after further adjustment for child race/ethnicity (HR 1.19, 95% CI 0.97-1.45). We observed increased risk of death when analyses were restricted to Hispanic children specifically (HR 1.30, 95% CI 1.03-1.65). Observations suggest that children with ALL residing in Hispanic enclaves experience inferior OS.
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Affiliation(s)
- Jeremy M. Schraw
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (E.C.P.-G.); (M.E.S.); (P.J.L.)
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Erin C. Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (E.C.P.-G.); (M.E.S.); (P.J.L.)
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Amy E. Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.E.H.); (S.L.P.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael E. Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (E.C.P.-G.); (M.E.S.); (P.J.L.)
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.E.H.); (S.L.P.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Philip J. Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (E.C.P.-G.); (M.E.S.); (P.J.L.)
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
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Indraswari BW, Kelling E, Vassileva SM, Sitaresmi MN, Danardono D, Mulatsih S, Supriyadi E, Widjajanto PH, Sutaryo S, Kaspers GL, Mostert S. Impact of universal health coverage on childhood cancer outcomes in Indonesia. Pediatr Blood Cancer 2021; 68:e29186. [PMID: 34114307 DOI: 10.1002/pbc.29186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low- and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital. METHODS Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained. FINDINGS After introduction of UHC, the number of insured patients increased from 38% to 82% (P < 0.001). Among low SES population, insurance coverage increased from 40% to 85% (P < 0.001), and among high SES population from 33% to 77% (P < 0.001). In the overall population, treatment abandonment decreased from 36% to 22% (P < 0.001). Event-free survival estimates at four years after diagnosis of overall population improved from 16% to 22% (P < 0.001). Hazard ratio for treatment failure was 1.26 (CI: 1.07-1.48, P = 0.006) for uninsured versus insured patients. In the low SES population, treatment abandonment decreased from 36% to 19% (P < 0.001). Event-free survival estimates at four years after diagnosis of low SES population improved from 14% to 22% (P < 0.001). INTERPRETATION Introduction of UHC in Indonesia contributed significantly to better treatment outcome and event-free survival of children with cancer from low SES families.
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Affiliation(s)
- Braghmandita Widya Indraswari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Emil Kelling
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sofi M Vassileva
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Danardono Danardono
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sutaryo Sutaryo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan L Kaspers
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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10
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Poulalhon C, Goujon S, Marquant F, Faure L, Guissou S, Bonaventure A, Désandes E, Rios P, Lacour B, Clavel J. Factors associated with 5- and 10-year survival among a recent cohort of childhood cancer survivors (France, 2000-2015). Cancer Epidemiol 2021; 73:101950. [PMID: 34214767 DOI: 10.1016/j.canep.2021.101950] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood cancer survival currently exceeds 80 % five years after diagnosis in high-income countries. In this study, we aimed to describe long-term trends and to investigate socioeconomic and spatial disparities in childhood cancer survival. METHODS The study included 28,073 cases recorded in the French National Registry of Childhood Cancers from 2000 to 2015. Contextual census data (deprivation indices, population density, spatial accessibility to general practitioners) were allocated to each case based on the residence at diagnosis. Overall survival (OS) and conditional 10-year OS for 5-year survivors were estimated for all cancers combined and by diagnostic group and subgroup. Comparisons were conducted by sex, age at diagnosis, period of diagnosis, and contextual indicators. Hazard ratios for death were estimated using Cox models. RESULTS All cancers combined, the OS reached 82.8 % [95 % CI: 82.4-83.3] at 5 years and 80.8 % [95 % CI: 80.3-81.3] at 10 years. Conditional 10-year OS of 5-year survivors reached 97.5 % [95 % CI: 97.3-97.7] and was higher than 95 % for all subgroups except osteosarcomas and most subgroups of the central nervous system. In addition to disparities by sex, age at diagnosis, and period of diagnosis, we observed a slight decrease in survival for cases living in the most deprived areas at diagnosis, not consistent across diagnostic groups. CONCLUSION Our results confirm the high 5-year survival for childhood cancer and show an excellent 10-year conditional survival of 5-year survivors. Additional individual data are needed to clarify the factors underlying the slight decrease in childhood cancer survival observed in the most deprived areas.
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Affiliation(s)
- Claire Poulalhon
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.
| | - Stéphanie Goujon
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Fabienne Marquant
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Laure Faure
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Sandra Guissou
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Audrey Bonaventure
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France
| | - Emmanuel Désandes
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Paula Rios
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France
| | - Brigitte Lacour
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Jacqueline Clavel
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
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11
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Boonhat H, Lin RT. Association between leukemia incidence and mortality and residential petrochemical exposure: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2020; 145:106090. [PMID: 32932064 DOI: 10.1016/j.envint.2020.106090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The global burden of leukemia, which grew by 19% from 2007 to 2017, poses a threat to human development and global cancer control. Factors contributing to this growth include massive industrial pollution, especially from large-scale petrochemical industry complexes (PICs). Globally, around 700 PICs are continuously operating. Data on the impact of PICs on leukemia incidence and mortality in residents are sparse and inconsistent. OBJECTIVE To determine the association between residential exposure to PICs and leukemia incidence and mortality using systematic review and meta-analysis. METHODS The studies were identified through seven databases (Clinical Key, Cochrane Library, EBSCOhost, Embase, PubMed, ScienceDirect, and Web of Science). We screened the eligibility of studies using following criteria: (1) observational studies that focused on residential exposure to PICs; (2) exposure group that was defined as residents living close to PICs; (3) outcome that was defined as all leukemia incidence and mortality; and (4) available population data. We applied the Grading of Recommendations Assessment, Development, and Evaluation to assess the certainty of evidence. The random-effects model used to estimate the pooled effects in the meta-analysis. RESULTS We identified thirteen epidemiologic studies (including eleven for leukemia incidence, one for leukemia mortality, and one for both), covering 125,580 individuals from Croatia, Finland, Italy, Serbia, Spain, Sweden, Taiwan, the United Kingdom, and the United States. We found moderate certainty of evidence indicated the risk of leukemia incidence (relative risk [RR] = 1.18; 95% CI = 1.03-1.35) and mortality (RR = 1.26; 95% CI = 1.10-1.45) in residents living close to PICs. Our subgroup analysis found increased RRs for leukemia incidence in studies using distance-based exposure indicator (RR = 1.11; 95% CI = 1.00-1.23), and with longer follow-up periods (RR = 1.24; 95% CI = 1.06-1.45). CONCLUSION Our analysis provides low-certainty evidence of increased leukemia incidence and moderate-certainty evidence of increased leukemia mortality among residents living close to PICs. While the global petrochemicals sector is growing, our findings suggest the need to consider disease prevention and pollution control measures during the development of PICs.
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Affiliation(s)
- Hathaichon Boonhat
- Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung 406, Taiwan
| | - Ro-Ting Lin
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung 406, Taiwan.
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12
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Westermann C, Weller J, Pedroso F, Canner J, Pratilas CA, Rhee DS. Socioeconomic and health care coverage disparities in children, adolescents, and young adults with sarcoma. Pediatr Blood Cancer 2020; 67:e28708. [PMID: 32939963 DOI: 10.1002/pbc.28708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Socioeconomic and health care coverage disparities are established as poor prognostic markers in adults with sarcoma, but few studies examine these differences among pediatric, adolescents and young adults (AYA). This study examines the association between socioeconomic status (SES), insurance status, and disease presentation among children and AYA patients with sarcoma. METHODS This is a retrospective cohort study of patients aged 0-25 years with bone or soft tissue sarcoma from the National Cancer Database. SES assignments were based on estimated median income and education level. Patient demographics and clinical factors were compared by SES and insurance status. Multivariate logistic regression models were fitted to determine adjusted odds ratios of SES and insurance status on metastatic disease or tumor size ≥5 cm at time of presentation. RESULTS In a cohort of 9112 patients, 2932 (32.1%) had low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%) were uninsured. Compared to high SES, patients with low SES were more likely to have metastatic disease (OR = 1.16, P = .03) and tumors ≥5 cm (OR = 1.29, P < .01). Compared to private insurance, public and no insurance were associated with metastatic disease (OR = 1.35, P < .01 and OR = 1.32, P = .02) and increased tumors ≥5 cm (OR = 1.28, P < .01 and OR = 1.67, P < .01). CONCLUSIONS SES disparities exist among children and AYA patients with sarcoma. Low SES and public or no insurance are associated with advanced disease at presentation. Further studies are needed to identify interventions to improve earlier detection of sarcomas in at-risk children and young adults.
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Affiliation(s)
- Carly Westermann
- Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Jennine Weller
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Felipe Pedroso
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joe Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine A Pratilas
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Treatment cost and access to care: experiences of young women diagnosed with breast cancer. Cancer Causes Control 2020; 31:1001-1009. [PMID: 32897529 DOI: 10.1007/s10552-020-01334-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Breast cancer is the leading cause of cancer-related deaths in women younger than 40 years. We aim to evaluate cost as a barrier to care among female breast cancer patients diagnosed between 18 to 39 years. METHODS In early 2017, we distributed a survey to women diagnosed with breast cancer between the ages of 18 and 39 years, as identified by the central cancer registries of California, Georgia, North Carolina, and Florida. We used multivariable statistics to explore cost-related barriers to receiving breast cancer care for the 830 women that completed the survey. RESULTS About half of the women (47.4%) reported spending more on breast cancer care than expected, and almost two-thirds (65.3%) had not discussed costs with their care team. A third of the patients (31.8%) indicated forgoing care due to cost. Factors associated with not receiving anticipated care due to cost included age less than35 years at diagnosis, self-insurance, comorbid conditions, and late-stage diagnosis. CONCLUSION Previous studies using breast cancer registry data have not included detailed insurance information and care received by young women. Young women with breast cancer frequently forgo breast cancer care due to cost. Our results highlight the potential for policies that facilitate optimal care for young breast cancer patients which could include the provision of comprehensive insurance coverage.
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14
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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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15
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Morshed N, Haskard-Zolnierek K, Zhan FB. Geographic Variations of Racial/Ethnic Disparities in Late-Stage Diagnosis of Childhood Cancer in Texas. South Med J 2020; 113:224-231. [PMID: 32358617 DOI: 10.14423/smj.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to identify small geographic areas where the childhood cancer yearly incidence and late-stage diagnosis rates were disproportionately higher among racial/ethnic minorities (Hispanics and non-Hispanic African Americans) in Texas. METHODS The study examined childhood cancer disparities in Texas from 2005 to 2014, based on geographic location and race/ethnicity. Relative (risk ratio) and absolute (risk difference) measures were used to investigate racial disparities of childhood cancer late-stage diagnosis in small geographic areas (census tracts). The study investigated childhood cancer yearly incidence- and late-stage diagnosis rates for three racial groups combined. The study also analyzed the temporal change of childhood cancer late-stage diagnosis rates based on the data from census tracts where disparities existed for Hispanics and non-Hispanic African Americans compared with a non-Hispanic white reference group. RESULTS A total of 54% of the cases in the study cohort were diagnosed in the late stage. Although there were fewer non-Hispanic African Americans cases compared with non-Hispanic white and Hispanic cases, they showed significant geographic variation in racial/ethnic disparities compared with the non-Hispanic white reference group. The study also revealed that 58 census tracts for non-Hispanic African Americans and 47 census tracts for Hispanics (of 5265) had significantly higher late-stage diagnosis rates compared with non-Hispanic whites. The findings also demonstrated consistent increases in incidence and late-stage diagnosis from 2005 to 2014 for all cases combined. CONCLUSIONS Most of the significant census tracts with a higher late-stage diagnosis rate for Hispanics were located on the outskirts of the Dallas-Fort Worth, Houston, and San Antonio areas. In contrast, geographic disparities of childhood cancer late-stage diagnosis for non-Hispanic African Americans were found inside the large metropolitan areas of Houston and Dallas-Fort Worth. The findings of this study will help prioritize the geographical allocation of resources, which, in turn, will help to facilitate preventive healthcare services and alleviate the disease burden in children.
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Affiliation(s)
- Niaz Morshed
- From the Departments of Geography and Psychology, Texas State University, San Marcos
| | | | - F Benjamin Zhan
- From the Departments of Geography and Psychology, Texas State University, San Marcos
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16
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Ayatollahi H, Bazi A, Sadeghian MH, Fani A, Siyadat P, Sheikhi M, Sargazi-Aval O. The Survival of Patients with t(15;17)(q22;q12) Positive Acute Promyelocytic Leukemia: A Study in North-East of Iran. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:175-181. [PMID: 32754212 PMCID: PMC7354063 DOI: 10.30699/ijp.2020.101417.2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/09/2019] [Indexed: 11/06/2022]
Abstract
Background & Objective Acute promyelocytic leukemia (APL) with t(15;17)(q22;q12) is a relatively common subtype of acute myeloid leukemia (AML). Here, our objective was to ascertain the survival of patients with this leukemia in north-east of Iran. Methods Survival rates of 42 APL patients with t(15;17)(q22;q12) were assessed. Clinical information was obtained from archived medical records. Statistical analysis was performed by SPSS 18 software using log-ranked test and Kaplan Maier survival analysis. Results Females and males comprised 49% and 51%, respectively. The mean age at diagnosis was 34.3 ± 14.1 years old. During the study period, 17 demises occurred in males, while this number was 7 in females. The mean survival of patients (month) was 23.22 ± 3.57 (95% CI: 16.21 ± 30.2). The five-year survival rate obtained 30%. Regarding demographic and clinical features, the highest rates of 5-year survival were recorded in patients with 20-35 years old (47.6%), males (51%), white blood cell count <10 × 10 9 /l (48%), and platelet count >140 × 10 9 /l (100%). Conclusion Younger age, lower WBC count and higher platelet count were significantly associated with longer survival in AML patients with t(15;17)(q22; q12).
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Affiliation(s)
- Hossein Ayatollahi
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Bazi
- Clinical Research Development Unit, Amir-Al-Momenin Hospital, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Hadi Sadeghian
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Fani
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Siyadat
- Department of Hematology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Sheikhi
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omolbanin Sargazi-Aval
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Hematology, Faculty of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran
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17
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Inverse Entezar Weibull and Its Application in Identification of Influential Factors on the Survival of Patients with Blood Cancers. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.87176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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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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19
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Moke DJ, Tsai K, Hamilton AS, Hwang A, Liu L, Freyer DR, Deapen D. Emerging Cancer Survival Trends, Disparities, and Priorities in Adolescents and Young Adults: A California Cancer Registry-Based Study. JNCI Cancer Spectr 2019; 3:pkz031. [PMID: 31276099 PMCID: PMC6597054 DOI: 10.1093/jncics/pkz031] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/07/2019] [Accepted: 04/24/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although landmark studies in the 1990s demonstrated that adolescents and young adults (AYAs, ages 15-39 years) with cancer had lower survival improvement compared to other ages, therapeutic advances warrant reappraisal of those observations. We utilized more recent data to study site-specific AYA survival trends and disparities and gain a more contemporary understanding of this problem. METHODS Using California Cancer Registry data from 1988 to 2014, we calculated 1) 5-year overall survival improvement for AYAs compared to other age groups; 2) hazard ratios (HRs) of death for AYAs comparing 2001-2014 with 1988-2000 stratified by site, stage, sex, age group, race and ethnicity, and socioeconomic status (SES); and 3) site-specific adjusted HRs (aHRs) for AYA risk groups and interaction analyses by time period. RESULTS For all cancers combined, AYAs demonstrated survival improvement that exceeded all other age groups, largely due to reduced mortality in human immunodeficiency virus and acquired immunodeficiency syndrome-related cancers. The strongest predictor of death was cancer stage (aHR = 6.32 for distant vs localized, 95% confidence interval [CI] = 6.20 to 6.45). The aHR of death was statistically significantly higher for blacks (1.46, 95% CI = 1.42 to 1.50), Asian and Pacific Islanders (1.12, 95% CI = 1.09 to 1.15), and Latino whites (1.06, 95% CI = 1.04 to 1.08) compared to non-Latino whites, and was statistically significantly higher for low SES compared to high (1.31, 95% CI = 1.29 to 1.34). Survival disparities by stage, race and ethnicity, and SES worsened over time. CONCLUSIONS For AYAs in aggregate, the historical cancer survival improvement gap has been closed. However, the growing survival disparities in AYA subsets reported here, including advanced stage disease, racial and ethnic minorities, and low SES, highlight new priorities in need of increased attention, including inequities in cancer care and delivery within this vulnerable population.
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Affiliation(s)
- Diana J Moke
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Kaiya Tsai
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | - Ann S Hamilton
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | - Amie Hwang
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA (AH, DRF, DD)
| | - Lihua Liu
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | - David R Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA (AH, DRF, DD)
| | - Dennis Deapen
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA (AH, DRF, DD)
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Brauer ER, Pieters HC, Ganz PA, Landier W, Pavlish C, Heilemann MV. Coming of Age With Cancer: Physical, Social, and Financial Barriers to Independence Among Emerging Adult Survivors. Oncol Nurs Forum 2018; 45:148-158. [PMID: 29466341 PMCID: PMC6162052 DOI: 10.1188/18.onf.148-158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the transition to self-care among a sample of emerging adult cancer survivors after hematopoietic cell transplantation (HCT).
. PARTICIPANTS & SETTING 18 HCT survivors who were aged 18-29 years at the time of HCT for a primary hematologic malignancy and were 8-60 months post-HCT participated in the study. The study took place in the hematology outpatient setting at City of Hope National Medical Center.
. METHODOLOGIC APPROACH The authors conducted in-depth semistructured interviews and analyzed interview transcripts using grounded theory methodology.
. FINDINGS Health-related setbacks following HCT disrupted not only participants' journey toward self-care, but also their overarching developmental trajectory toward adulthood. Physically, participants struggled with lack of personal space around caregivers, but felt unready to live on their own. Socially, they relied on multiple caregivers to avoid relying too much on any one person. Financially, participants worried about prolonged dependence and increased needs in the future.
. IMPLICATIONS FOR NURSING Nurses can support the transition to self-care among emerging adults after HCT by recognizing the broader developmental impact of their cancer experience.
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Affiliation(s)
- Eden R. Brauer
- UCLA Jonsson Comprehensive Cancer Center, Center for Cancer Prevention & Control Research, Box 956900, A2-125 CHS, Los Angeles, CA 90095-6900, , Telephone: (310) 724-7525, Fax: (310) 206-3566
| | | | - Patricia A. Ganz
- UCLA Schools of Medicine and Public Health, UCLA Jonsson Comprehensive Cancer Center,
| | - Wendy Landier
- University of Alabama at Birmingham, School of Medicine,
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22
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Maese L, Tasian SK, Raetz EA. How is the Ph-like signature being incorporated into ALL therapy? Best Pract Res Clin Haematol 2017; 30:222-228. [PMID: 29050695 PMCID: PMC6053910 DOI: 10.1016/j.beha.2017.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/09/2017] [Indexed: 01/09/2023]
Abstract
Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) is a recently identified high risk disease subtype characterized by a gene expression profile similar to that observed in Philadelphia chromosome-positive (Ph-positive) ALL, but without an underlying BCR-ABL1 translocation. Adults and children with Ph-like ALL harbor a diversity of alterations that all lead to activated kinase signaling. Outcomes for patients with Ph-like ALL are poor, which has prompted investigation into the role of tyrosine kinase inhibitor (TKI)-based therapies for this disease. Several clinical trials are now ongoing that include screening for the Ph-like signature and treatment of patients with Ph-like ALL with TKI therapy. This review examines how testing for Ph-like ALL is being incorporated into clinical trials.
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Affiliation(s)
- Luke Maese
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sarah K Tasian
- Department of Pediatrics, Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Elizabeth A Raetz
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Smits-Seemann RR, Pettit J, Li H, Kirchhoff AC, Fluchel MN. Infection-related mortality in Hispanic and non-Hispanic children with cancer. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26502. [PMID: 28436579 PMCID: PMC6719562 DOI: 10.1002/pbc.26502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hispanic children with cancer experience poorer survival than their White counterparts. Infection is a known cause of cancer-related mortality; however, little is known about the risk of infection-related death among Hispanic children with cancer. We examine the association of Hispanic ethnicity with infection-related mortality and life-threatening events among children with cancer. PROCEDURE For a cohort of all pediatric cancer patients diagnosed from 1986 to 2012 and treated at a single tertiary care center, we obtained national death records to determine all-cause mortality and infection-related mortality, as well as intensive care unit (ICU) admissions as a surrogate for life-threatening events. Cox proportional hazard models assessed all-cause mortality and infection-related mortality using ethnicity as the main independent variable. ICU admission rates were modeled using a zero-inflated Poisson regression model. Models were adjusted for gender, diagnosis year, age, residential location, and diagnosis. RESULTS Of 6,198 patients, 741 (12%) were Hispanic. Mean follow-up was 11 years (SD = 8.04). There were 1,205 deaths, with 193 attributable to infection. Differences in all-cause mortality between Hispanic and non-Hispanic patients did not reach significance (hazard ratio [HR] = 1.14, 95% confidence interval [CI]: 0.96-1.36). However, Hispanic patients were 68% (HR = 1.68, 95% CI: 1.16-2.43) more likely to have an infection-related cause of death. Hispanic ethnicity was statistically associated with a higher rate of ICU admissions (rate ratio = 1.32, 95% CI: 1.12-1.56). CONCLUSION Hispanic pediatric cancer patients were more likely to have an infection-related death and higher rates of ICU admissions than non-Hispanic patients. Infection may be an overlooked contributor to poorer outcomes among Hispanic patients.
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Affiliation(s)
- Rochelle R. Smits-Seemann
- Department of Institutional Research and Reporting, Salt Lake Community College, Salt Lake City, Utah
| | | | - Hongyan Li
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Mark N. Fluchel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah,Primary Children’s Hospital, Salt Lake City, Utah
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Srour SA, Machiorlatti M, Pierson NT, Bhutta UZ, Cherry M, Selby GB, Thompson DM, Vesely SK, Kurkjian CD. Impact of Health Care Insurance Status on Treatment Outcomes of Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [DOI: 10.1016/j.clml.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Green AL, Furutani E, Ribeiro KB, Rodriguez Galindo C. Death Within 1 Month of Diagnosis in Childhood Cancer: An Analysis of Risk Factors and Scope of the Problem. J Clin Oncol 2017; 35:1320-1327. [PMID: 28414926 DOI: 10.1200/jco.2016.70.3249] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose Despite advances in childhood cancer care, some patients die soon after diagnosis. This population is not well described and may be under-reported. Better understanding of risk factors for early death and scope of the problem could lead to prevention of these occurrences and thus better survival rates in childhood cancer. Methods We retrieved data from SEER 13 registries on 36,337 patients age 0 to 19 years diagnosed with cancer between 1992 and 2011. Early death was defined as death within 1 month of diagnosis. Socioeconomic status data for each individual's county of residence were derived from Census 2000. Crude and adjusted odds ratios and corresponding 95% CIs were estimated for the association between early death and demographic, clinical, and socioeconomic factors. Results Percentage of early death in the period was 1.5% (n = 555). Children with acute myeloid leukemia, infant acute lymphoblastic leukemia, hepatoblastoma, and malignant brain tumors had the highest risk of early death. On multivariable analysis, an age younger than 1 year was a strong predictor of early death in all disease groups examined. Black race and Hispanic ethnicity were both risk factors for early death in multiple disease groups. Residence in counties with lower than median average income was associated with a higher risk of early death in hematologic malignancies. Percentages of early death decreased significantly over time, especially in hematologic malignancies. Conclusion Risk factors for early death in childhood cancer include an age younger than 1 year, specific diagnoses, minority race and ethnicity, and disadvantaged socioeconomic status. The population-based disease-specific percentages of early death were uniformly higher than those reported in cooperative clinical trials, suggesting that early death is under-reported in the medical literature. Initiatives to identify those at risk and develop preventive interventions should be prioritized.
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Affiliation(s)
- Adam L Green
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Elissa Furutani
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Karina Braga Ribeiro
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Carlos Rodriguez Galindo
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
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Kazak AE, Barakat LP, Askins MA, McCafferty M, Lattomus A, Ruppe N, Deatrick J. Provider Perspectives on the Implementation of Psychosocial Risk Screening in Pediatric Cancer. J Pediatr Psychol 2017; 42:700-710. [DOI: 10.1093/jpepsy/jsw110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/27/2016] [Indexed: 01/24/2023] Open
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Simony SB, Lund LW, Erdmann F, Andersen KK, Winther JF, Schüz J, Johansen C, Schmiegelow K, Dalton SO. Effect of socioeconomic position on survival after childhood cancer in Denmark. Acta Oncol 2016; 55:742-50. [PMID: 26935257 DOI: 10.3109/0284186x.2016.1144933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 11/13/2022]
Abstract
Background One fifth of all deaths among children in Europe are accounted for by cancer. If this is to be reduced there is a need for studies on not only biology and treatment approaches but also on how social factors influence cure rates. We investigated how various socioeconomic characteristics were associated with survival after childhood cancer. Material and methods In a nationwide cohort of 3797 children diagnosed with cancer [hematological cancer, central nervous system (CNS) tumors, non-CNS solid tumors] before age 20 between 1990 and 2009 we identified parents and siblings and obtained individual level parental socioeconomic variables and vital status through 2012 by linkage to population-based registries. Hazard ratios (HR) and 95% confidence intervals (CI) for dying were estimated using multivariate Cox proportional hazard models. Results For all children with cancer combined, survival was slightly but not statistically significantly better the higher the education of the mother or the father, and with maternal income. Significantly better survival was observed when parents were living together compared to living alone and worse survival when the child had siblings compared to none. Young (<20) or older (≥40) maternal age showed non-significant associations, but based on small numbers. For hematological cancers, no significant associations were observed. For CNS tumors, better survival was seen with parents living together (HR 0.70, CI 0.51-0.97). For non-CNS solid tumors, survival was better with high education of the mother (HR 0.66, CI 0.44-0.99) compared to basic and worse for children with one (HR 1.45, CI 1.11-1.89) or two or more siblings (HR 1.29, CI 0.93-1.79) (p for trend 0.02) compared to none. Conclusion The impact of socioeconomic characteristics on childhood cancer survival, despite equal access to protocolled and free-of-charge treatment, warrants further and more direct studies of underlying mechanisms in order to target these as a means to improve survival rates.
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Affiliation(s)
- Sofie B Simony
- a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Lasse W Lund
- a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark
- b Department of Pediatrics & Adolescent Medicine , University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Friederike Erdmann
- c Section of Environment and Radiation, International Agency for Research on Cancer (IARC) , Lyon Cedex , France
| | - Klaus K Andersen
- d Unit of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Jeanette F Winther
- a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Joachim Schüz
- c Section of Environment and Radiation, International Agency for Research on Cancer (IARC) , Lyon Cedex , France
| | - Christoffer Johansen
- a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark
- e The Department of Oncology , University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Kjeld Schmiegelow
- b Department of Pediatrics & Adolescent Medicine , University Hospital Rigshospitalet , Copenhagen , Denmark
- f Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
| | - Susanne O Dalton
- a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark
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Green AL, Chintagumpala M, Krailo M, Langholz B, Albert D, Eagle R, Cockburn M, Chevez-Barrios P, Rodriguez-Galindo C. Correlation of Insurance, Race, and Ethnicity with Pathologic Risk in a Controlled Retinoblastoma Cohort: A Children's Oncology Group Study. Ophthalmology 2016; 123:1817-1823. [PMID: 27262763 DOI: 10.1016/j.ophtha.2016.04.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether insurance status, race, and ethnicity correlate with increased retinoblastoma invasiveness as a marker of both risk and time to diagnosis. DESIGN Retrospective case-control study. PARTICIPANTS All 203 patients from the United States enrolled in the Children's Oncology Group (COG) trial ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. MAIN OUTCOME MEASURES All surgical specimens underwent pathologic review to determine the presence of well-defined histopathologic features correlating with a higher risk of disease progression. Insurance status, race, and ethnicity were compiled from the study record for each patient. RESULTS On institutional pathologic review, nonprivate insurance, nonwhite race, and Hispanic ethnicity all correlated significantly with a greater rate of high-risk pathologic findings. Hispanic ethnicity remained a significant predictor on multivariate analysis. On central pathologic review, these correlations remained but did not reach statistical significance. The differences in results from institutional versus central pathologic reviews appeared to be due to a higher likelihood of patients in minority groups of being misclassified as high risk by institutional pathologists. CONCLUSIONS In this controlled study population of patients with retinoblastoma who had central pathologic review, our findings suggest a higher rate of more advanced disease associated with nonprivate insurance, nonwhite race, and Hispanic ethnicity; these findings may be due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English-language proficiency and socioeconomic status. Further effort also should focus on where in the diagnostic process potential delays exist, so that interventions can be designed to overcome barriers to care for these groups. In addition, potential systematic differences in pathologic reads based on demographic variables deserve further study.
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Affiliation(s)
- Adam L Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
| | - Murali Chintagumpala
- Texas Children's Cancer Center, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Mark Krailo
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Bryan Langholz
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Daniel Albert
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ralph Eagle
- Pathology Department, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Myles Cockburn
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Carlos Rodriguez-Galindo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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Wolfson JA, Sun CL, Wyatt LP, Hurria A, Bhatia S. Impact of care at comprehensive cancer centers on outcome: Results from a population-based study. Cancer 2015; 121:3885-93. [PMID: 26218755 PMCID: PMC4892698 DOI: 10.1002/cncr.29576] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rigorous processes ensure quality of research and clinical care at National Cancer Institute-designated comprehensive cancer centers (NCICCCs). Unmeasurable elements of structure and process of cancer care delivery warrant evaluation. To the authors' knowledge, the impact of NCICCC care on survival and access to NCICCCs for vulnerable subpopulations remain unstudied. METHODS The current study's population-based cohort of 69,579 patients had newly diagnosed adult-onset (aged 22-65 years) cancers reported to the Los Angeles County cancer registry between 1998 and 2008. Geographic information systems were used for geospatial analysis. RESULTS With regard to overall survival across multiple diagnoses, patients not receiving their first planned treatment at NCICCCs experienced poorer outcomes compared with those treated at NCICCCs; differences persisted on multivariable analyses after adjusting for clinical and sociodemographic factors (hepatobiliary: hazard ratio [HR], 1.5; 95% confidence interval [95% CI], 1.4-1.7 [P<.001]; lung: HR, 1.4; 95% CI, 1.3-1.6 [P<.001]; pancreatic: HR, 1.5; 95% CI, 1.3-1.7 [P<.001]; gastric: HR, 1.3; 95% CI, 1.1-1.7 [P = .01]; breast: HR, 1.3; 95% CI, 1.1-1.5 [P<.001]; and colorectal: HR, 1.2; 95% CI, 1.0-1.4 [P = .05]). With regard to barriers to care, multivariable analyses revealed that a lower likelihood of treatment at NCICCCs was associated with race/ethnicity (African-American: OR range across diagnoses: 0.4-0.7 [P<.03]; Hispanic: OR range, 0.5-0.7 [P<.04]); lack of private insurance (public: OR range, 0.6-0.8 [P<.004]; uninsured: OR range, 0.1-0.5 [P<.04]); less than high socioeconomic status (high-middle: OR range, 0.4-0.7 [P<.02]; middle: OR range, 0.3-0.5 [P<.001]; and low: OR range, 0.2-0.6 [P<.01]), and residing >9 miles from the nearest NCICCC (OR range, 0.5-0.7 [P<.02]). CONCLUSIONS Among individuals aged 22 to 65 years residing in Los Angeles County with newly diagnosed adult-onset cancer, those who were treated at NCICCCs experienced superior survival compared with those treated at non-NCICCC facilities. Barriers to care at NCICCCs included race/ethnicity, insurance, socioeconomic status, and distance to an NCICCC.
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Affiliation(s)
- Julie A Wolfson
- Department of Population Sciences, City of Hope, Duarte, California
| | - Can-Lan Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | - Laura P Wyatt
- Department of Population Sciences, City of Hope, Duarte, California
| | - Arti Hurria
- Department of Population Sciences, City of Hope, Duarte, California
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, Duarte, California
- Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama
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Wolfson JA. Piecing together the puzzle of disparities in adolescents and young adults. Cancer 2015; 121:1168-71. [PMID: 25491090 PMCID: PMC4393349 DOI: 10.1002/cncr.29193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Julie A Wolfson
- Department of Population Sciences, City of Hope, Duarte, California
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31
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Petridou ET, Sergentanis TN, Perlepe C, Papathoma P, Tsilimidos G, Kontogeorgi E, Kourti M, Baka M, Moschovi M, Polychronopoulou S, Sidi V, Hatzipantelis E, Stiakaki E, Iliadou AN, La Vecchia C, Skalkidou A, Adami HO. Socioeconomic disparities in survival from childhood leukemia in the United States and globally: a meta-analysis. Ann Oncol 2015; 26:589-597. [PMID: 25527416 DOI: 10.1093/annonc/mdu572] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Despite advancements in the treatment of childhood leukemia, socioeconomic status (SES) may potentially affect disease prognosis. This study aims to evaluate whether SES is associated with survival from childhood leukemia. METHODS The US National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 1973-2010 data were analyzed; thereafter, results were meta-analyzed along with those from survival (cohort) studies examining the association between SES indices and survival from childhood leukemia (end-of-search date: 31 March 2014). Random-effects models were used to calculate pooled effect estimates (relative risks, RRs); meta-regression was also used. RESULTS We included 29 studies yielding 28 804 acute lymphoblastic leukemia (ALL), 3208 acute myeloblastic leukemia (AML) and 27 650 'any' leukemia (denoting joint reporting of all subtypes) cases. According to individual-level composite SES indices, children from low SES suffered from nearly twofold higher death rates from ALL (pooled RR: 1.83, 95% confidence interval 1.00-3.34, based on four study arms); likewise, death RRs derived from an array of lower area-level SES indices ranged between 1.17 and 1.33 (based on 11 study arms). Importantly, the survival gap between higher and lower SES seemed wider in the United States, with considerably (by 20%-82%) increased RRs for death from ALL in lower SES. Regarding AML, poorer survival was evident only when area-level SES indices were used. Lastly, remoteness indices were not associated with survival from childhood leukemia. CONCLUSION Children with lower SES suffering childhood leukemia do not seem to equally enjoy the impressive recent survival gains. Special health policy strategies and increased awareness of health providers might minimize the effects of socioeconomic disparities.
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Affiliation(s)
- E T Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - T N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - C Perlepe
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - P Papathoma
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - G Tsilimidos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - E Kontogeorgi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - M Kourti
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - M Baka
- Department of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital, Athens
| | - M Moschovi
- First Department of Pediatrics, Athens University Medical School
| | - S Polychronopoulou
- Department of Pediatric Hematology-Oncology, 'Aghia Sophia' General Children's Hospital, Athens
| | - V Sidi
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - E Hatzipantelis
- 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki
| | - E Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - A N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - A Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - H O Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Epidemiology, Harvard School of Public Health, Boston, USA
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Gupta S, Sutradhar R, Guttmann A, Sung L, Pole JD. Socioeconomic status and event free survival in pediatric acute lymphoblastic leukemia: a population-based cohort study. Leuk Res 2014; 38:1407-12. [PMID: 25224660 DOI: 10.1016/j.leukres.2014.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/19/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
The impact of socioeconomic status (SES) upon childhood cancer outcomes has not been extensively examined. Our objective was to determine the association between SES and event-free survival (EFS) among children with acute lymphoblastic leukemia (ALL) diagnosed in Ontario, Canada from 1995-2011 (N=1541) using Cox proportional hazards. Neither neighborhood-level median income quintile, distance from tertiary center, or rural residence significantly predicted EFS in the context of a universal healthcare system. Immigrant children experienced significantly superior EFS; confounding by ethnicity could not be ruled out. Confirmatory studies using additional individual-level SES variables are warranted.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, Department of Paediatrics and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Canada M4N 3M5; Dalla Lana School of Public Health, University of Toronto, 6th floor, 155 College Street, Toronto, Canada M5T 3M7
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Canada M4N 3M5; Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8; Institute of Health Policy, Management and Evaluation, University of Toronto, Suite 425, 155 College Street, Toronto, Canada M5T 3M6
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Paediatrics and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8; Institute of Health Policy, Management and Evaluation, University of Toronto, Suite 425, 155 College Street, Toronto, Canada M5T 3M6
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Suite 1014, 480 University Avenue, Toronto, Canada M5G 1V2
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Erdmann F, Kaatsch P, Zeeb H, Roman E, Lightfoot T, Schüz J. Survival from childhood acute lymphoblastic leukaemia in West Germany: does socio-demographic background matter? Eur J Cancer 2014; 50:1345-53. [PMID: 24582913 DOI: 10.1016/j.ejca.2014.01.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children. METHODS ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival. RESULTS Overall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level. CONCLUSION Socio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 69, 55101 Mainz, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, 28359 Bremen, Germany
| | - Eve Roman
- Department of Health Sciences, Epidemiology & Cancer Statistics Group, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Tracy Lightfoot
- Department of Health Sciences, Epidemiology & Cancer Statistics Group, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France
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Gupta S, Wilejto M, Pole JD, Guttmann A, Sung L. Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. PLoS One 2014; 9:e89482. [PMID: 24586813 PMCID: PMC3935876 DOI: 10.1371/journal.pone.0089482] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/21/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. METHODS We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. RESULTS Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. CONCLUSIONS Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marta Wilejto
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason D. Pole
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Disparities in stage at diagnosis among adults with testicular germ cell tumors in the National Cancer Data Base. Urol Oncol 2014; 32:23.e15-21. [DOI: 10.1016/j.urolonc.2012.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/10/2012] [Accepted: 08/13/2012] [Indexed: 11/20/2022]
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Nguyen DK, Maggard-Gibbons M. Age, poverty, acculturation, and gastric cancer. Surgery 2013; 154:444-52. [PMID: 23972650 DOI: 10.1016/j.surg.2013.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gastric cancer is an aggressive disease, and overall changes in incidence rates have been noted. There are conflicting data on whether young patients have worse outcomes than older patients; the roles of tumor biology and access to care are critical to answering this question. Our objectives were to explore how gastric cancer rates, receipt of care, and outcomes are affected by age, poverty, and acculturation. METHODS A total of 42,187 patients were identified from the 1980-2009 Surveillance, Epidemiology, and End Results registry. We compared trends in incidence rates between patients <40, 40-64, and ≥65 years using ordinary least-squares regression. Separate multivariate regression models were used to evaluate the impact of age, poverty, and acculturation on receipt of cancer-directed therapy and hazard of mortality. RESULTS Patients <40 years had stable incidence rates over the 3-decade period compared with decreases for patients 40-64 and ≥65 years. They are also more likely to present with aggressive, advanced disease (P < .0001 for both). On unadjusted and adjusted analyses, patients <40 years were more likely to receive cancer-directed therapies and have better survival than those ≥65 years. Residing in high poverty areas was associated with not receiving appropriate cancer-directed therapy; the adjusted hazard ratio of mortality for surgically resected patients was, however, not affected by poverty. Residing in high immigration areas was associated with a low hazard ratio (HR, 0.74; 95% confidence interval [CI], 0.7-0.79) of mortality. Foreign-born patients also had a low hazard ratio (HR, 0.87; 95% CI, 0.83-0.91) of mortality. CONCLUSION Although trends in incidence rates for patients <40 years remain unchanged and their disease is aggressive and advanced at presentation, they do not experience disparities in gastric cancer-directed therapies and survival after resection. For patients residing in impoverished areas or high immigration communities, operative resection and adjustment for appropriate aftercare is associated with comparable or better survival when compared with those living in low poverty or low immigration areas. Disparities remain in receipt of appropriate cancer-directed therapies, and future efforts should focus on decreasing structural variations in care and unconscious biases regarding patients from these vulnerable communities.
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Affiliation(s)
- David K Nguyen
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.
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Falchi L, Keating MJ, Wang X, Coombs CC, Lanasa MC, Strom S, Wierda WG, Ferrajoli A. Clinical characteristics, response to therapy, and survival of African American patients diagnosed with chronic lymphocytic leukemia: joint experience of the MD Anderson Cancer Center and Duke University Medical Center. Cancer 2013; 119:3177-85. [PMID: 24022787 PMCID: PMC4394603 DOI: 10.1002/cncr.28030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/21/2012] [Accepted: 02/05/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known regarding racial disparities in characteristics and outcomes among patients with chronic lymphocytic leukemia (CLL). METHODS The characteristics and outcomes of untreated African American (AA) patients with CLL (n = 84) were analyzed and compared with a reference nonblack (NB) patient population (n = 1571). RESULTS At the time of presentation, AA patients had lower median hemoglobin levels (12.9 g/dL vs 13.7 g/dL), higher β2 microglobulin levels (2.7 mg/dL vs 2.4 mg/dL), greater frequency of constitutional symptoms (27% vs 10%), unmutated immunoglobulin heavy-chain variable region (IGHV) mutation status (65% vs 47%), ζ-chain-associated protein kinase 70 (ZAP70) expression (58% vs 32%), and deletion of chromosome 17p or chromosome 11q (28% vs 17%; P ≤ 02 for each comparison). Fifty-one percent of AA patients and 39% of NB patients required first-line therapy and 91% and 88%, respectively, received chemoimmunotherapy. Overall response rates to treatment were 85% for AA patients and 94% for NB patients (P = .06); and the complete response rates were 56% and 58%, respectively (P = .87). The median survival of AA patients was shorter compared with that of NB patients (event-free survival: 36 months vs 61 months; P = .007; overall survival: 152 months vs not reached; P = .0001). AA race was an independent predictor of shorter event-free and overall survival in multivariable regression models. CONCLUSIONS The current results indicated that AA patients with CLL have more unfavorable prognostic characteristics and shorter survival compared with their NB counterparts.
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MESH Headings
- ADP-ribosyl Cyclase 1/analysis
- Academic Medical Centers
- Adult
- Black or African American/genetics
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Chromosomes, Human, Pair 17
- Disease-Free Survival
- Female
- Gene Deletion
- Gene Expression Regulation, Neoplastic
- Health Status Disparities
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Medical Records Systems, Computerized
- Middle Aged
- North Carolina/epidemiology
- Risk Assessment
- Risk Factors
- Texas/epidemiology
- ZAP-70 Protein-Tyrosine Kinase/genetics
- beta 2-Microglobulin/blood
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Affiliation(s)
- Lorenzo Falchi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael J. Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Catherine C. Coombs
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mark C. Lanasa
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sara Strom
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Socioeconomic variation in survival from childhood leukaemia in northern England, 1968-2010. Br J Cancer 2013; 108:2339-45. [PMID: 23652301 PMCID: PMC3681006 DOI: 10.1038/bjc.2013.222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Despite marked improvements in childhood leukaemia survival, 20% still die within 5 years of diagnosis. The aim of this study was to evaluate the relationship between socioeconomic status, as assessed by paternal occupation at birth, and survival from childhood leukaemia in children, using data from the Northern Region Young Persons Malignant Disease Registry. Methods: All 1007 cases of leukaemia in children aged 0–14 years, diagnosed between 1968 and 2010 and registered with the Registry were studied. Paternal occupational social class at the time of the child's birth was obtained and analysed in relation to survival using Cox-proportional regression. Results: Compared with the most advantaged group (I/II), those in the middle group (IIIN/M) had a 68% increased risk of death, while those in the least advantaged group (IV/V) had 86% higher risk for acute lymphoblastic leukaemia. While the survival advantage of children in class I/II was apparent from the time of diagnosis, survival for children in groups IIIN/M and IV/V were comparable until 3–4 years after diagnosis, when they began to minimally diverge. Conclusion: The existence of such socioeconomic disparities cannot be attributed to accessibility to health care in the United Kingdom. Further research into the likely factors underlying these disparities is required.
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Childhood leukemia and lymphoma: time trends and factors affecting survival in five Southern and Eastern European Cancer Registries. Cancer Causes Control 2013; 24:1111-8. [PMID: 23529470 DOI: 10.1007/s10552-013-0188-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/14/2013] [Indexed: 12/22/2022]
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Haggar FA, Pereira G, Preen DD, Holman CDJ, Einarsdottir K. Cancer survival and excess mortality estimates among adolescents and young adults in Western Australia, 1982-2004: a population-based study. PLoS One 2013; 8:e55630. [PMID: 23405184 PMCID: PMC3566059 DOI: 10.1371/journal.pone.0055630] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/03/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Data are limited on cancer outcomes in adolescents and young adults. METHODS Based on data from the Western Australian Data Linkage System, this study modelled survival and excess mortality in all adolescents and young adults aged 15-39 years in Western Australia who had a diagnosis of cancer in the period 1982-2004. Relative survival and excess all-cause mortality for all cancers combined and for principal tumour subgroups were estimated, using the Ederer II method and generalised linear Poisson modelling, respectively. RESULTS A cancer diagnosis in adolescents and young adults conferred substantial survival decrement. However, overall outcomes improved over calendar period (excess mortality hazard ratio [HR], latest versus earliest diagnostic period: 0.52, trend p<0.0001). Case fatality varied according to age group (HR, oldest versus youngest: 1.38, trend p<0.0001), sex (HR, female versus male: 0.66, 95% confidence interval [CI] 0.62-0.71), ethnicity (HR, Aboriginal versus others: 1.47, CI 1.23-1.76), geographical area (HR, rural/remote versus urban: 1.13, CI 1.04-1.23) and residential socioeconomic status (HR, lowest versus highest quartile: 1.14, trend p<0.05). Tumour subgroups differed substantially in frequency according to age group and sex, and were critical outcome determinants. CONCLUSIONS Marked progressive calendar-time improvement in overall outcomes was evident. Further research is required to disentangle the contributions of tumour biology and health service factors to outcome disparities between ethno-demographic, geographic and socioeconomic subgroups of adolescents and young adults with cancer.
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Affiliation(s)
- Fatima A Haggar
- School of Population Health, Centre for Health Services Research, The University of Western Australia, Crawley, Australia.
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Understanding disparities in leukemia: a national study. Cancer Causes Control 2012; 23:1831-7. [PMID: 22971999 DOI: 10.1007/s10552-012-0062-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 08/28/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE Disparities in solid tumors have been well studied. However, disparities in hematologic malignancies have been relatively unexplored on population-based levels. The purpose of this study is to examine the relationship between race/ethnicity and acute leukemia mortality. METHODS All patients with acute leukemia [acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)] were identified in the Surveillance Epidemiology and End Results database, 1999-2008. Kaplan-Meier curves were generated to reflect survival probabilities by race/ethnicity. Multivariable Cox proportional hazard models estimated hazard of mortality by race with adjustment for individual (age, gender, year of diagnosis) and select genetic factors. RESULTS A total of 39,002 patients with acute leukemia were included in the study. Overall, there was a mortality disparity in acute leukemia for blacks (HR 1.17, p < 0.0001) and Hispanics (HR 1.13, p < 0.0001) compared with non-Hispanic whites. In stratified analysis, disparities in ALL were greater than AML; blacks (HR[ALL]1.45, p < 0.0001; HR[AML]1.12, p < 0.0011); Hispanics (HR[ALL]1.46, p < 0.0001; HR[AML]1.06, p < 0.0001). Adjustment for individual patient and select genetic factors did not explain disparities. CONCLUSIONS Blacks and Hispanics suffer decreased survival in acute leukemia as compared to others. Further investigation is needed to understand the drivers of poor cancer outcomes in these populations.
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Keegan THM, Lichtensztajn DY, Kato I, Kent EE, Wu XC, West MM, Hamilton AS, Zebrack B, Bellizzi KM, Smith AW. Unmet adolescent and young adult cancer survivors information and service needs: a population-based cancer registry study. J Cancer Surviv 2012; 6:239-50. [PMID: 22457219 PMCID: PMC3433596 DOI: 10.1007/s11764-012-0219-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We described unmet information and service needs of adolescent and young adult (AYA) cancer survivors (15-39 years of age) and identified sociodemographic and health-related factors associated with these unmet needs. METHODS We studied 523 AYAs recruited from seven population-based cancer registries, diagnosed with acute lymphocytic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma, germ cell cancer, or sarcoma in 2007-2008. Participants completed surveys a median of 11 months from diagnosis. Multivariable logistic regression analyses were used to estimate associations between unmet (information and service) needs and sociodemographic and health-related factors. RESULTS More than half of AYAs had unmet information needs relating to their cancer returning and cancer treatments. AYAs needing services, but not receiving them, ranged from 29 % for in-home nursing to 75 % for a support group. The majority of AYAs who needed a pain management expert, physical/occupational therapist, mental health worker, or financial advice on paying for health care did not receive services. In multivariable analyses, older participants, men, participants of non-white race/ethnicity, and participants who reported less than excellent general health or fair/poor quality of care were more likely to report unmet information needs. Factors associated with both unmet service and information needs included physical health or emotional problems interfering with social activities or having ≥3 physical treatment-related symptoms. CONCLUSIONS Recently diagnosed AYA cancer survivors have substantial unmet information needs varying by demographic and health-related factors. IMPLICATIONS FOR CANCER SURVIVORS We identified subgroups of AYA cancer survivors with high unmet needs that can be targeted for interventions and referrals.
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Kent EE, Sender LS, Morris RA, Grigsby TJ, Montoya MJ, Ziogas A, Anton-Culver H. Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma. Qual Life Res 2012; 22:1339-51. [PMID: 22922952 DOI: 10.1007/s11136-012-0254-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer registry survival analyses have shown that adolescent and young adult patients with low socioeconomic status (SES) have reduced survival compared to those with higher SES. The objective of this study was to determine whether neighborhood- (nSES) and/or individual-level SES (iSES) also predicted current quality of life in adolescent and young adult survivors. METHODS The Socioeconomics and Quality of Life study surveyed adolescent and young adult survivors of leukemia and lymphoma at least one year post-diagnosis using population-based ascertainment. Factor analysis was used to create a multidimensional age-relevant iSES score and compared with a preexisting census-block-group derived nSES score. Four quality of life domains were assessed: physical health, psychological and emotional well-being, social relationships, and life skills. Nested multivariable linear regression models were run to test the associations between both SES measures and quality of life and to compare the explanatory power of nSES and iSES. RESULTS Data from 110 individuals aged 16-40 were included in the final analysis. After adjustment for sociodemographic confounders, low nSES was associated only with poorer physical health, whereas low iSES was related to poorer quality of life in all four domains with iSES accounting for an additional 14, 12, 25, and 10 % of the variance, respectively. CONCLUSIONS Measures of SES at the individual as compared to the neighborhood level may be stronger indicators of outcomes in adolescents and young adults, which has important implications for SES measurement in the context of cancer surveillance.
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Affiliation(s)
- Erin E Kent
- Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, 6116 Executive Blvd, Bethesda, MD 20892, USA.
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Kent EE, Parry C, Montoya MJ, Sender LS, Morris RA, Anton-Culver H. "You're too young for this": adolescent and young adults' perspectives on cancer survivorship. J Psychosoc Oncol 2012; 30:260-79. [PMID: 22416959 DOI: 10.1080/07347332.2011.644396] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult. Future intervention development for adolescent and young adult survivors should involve patient voices at each stage of the research process.
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Affiliation(s)
- Erin E Kent
- Cancer Prevention Fellowship Program and Office of Cancer Survivorship, National Cancer Institute, National Institutes of Health, Rockville, MD 20852, USA.
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Bleyer A, Ulrich C, Martin S. Young adults, cancer, health insurance, socioeconomic status, and the Patient Protection and Affordable Care Act. Cancer 2012; 118:6018-21. [DOI: 10.1002/cncr.27685] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 11/10/2022]
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Lightfoot T, Johnston W, Simpson J, Smith A, Ansell P, Crouch S, Roman E, Kinsey S. Survival from childhood acute lymphoblastic leukaemia: the impact of social inequality in the United Kingdom. Eur J Cancer 2012; 48:263-9. [DOI: 10.1016/j.ejca.2011.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
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Racial Differences in the Presentation and Outcomes of Chronic Lymphocytic Leukemia and Variants in the United States. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:498-506. [DOI: 10.1016/j.clml.2011.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 02/02/2023]
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The impact of insurance status on actuarial survival in hospitalized trauma patients: when do they die? ACTA ACUST UNITED AC 2011; 70:130-4; discussion 134-5. [PMID: 21217490 DOI: 10.1097/ta.0b013e3182032b34] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous work has suggested that insurance status, gender, and ethnicity all have an independent association with mortality after trauma. The purpose of this study is to investigate whether these factors exerted survival impact that could be observed throughout the hospital stay. METHODS Using the National Trauma Data Bank (version 7.0), a Cox proportional hazards survival analysis was performed on young (19-30 years old) trauma patients to mitigate the impact of comorbid confounders. Variables included in the model were age, gender, ethnicity, Injury Severity Score, presence of shock at presentation, mechanism of injury, insurance status, year of admission, teaching status of the hospital, diagnosis of substance abuse or psychotic disorders, and complications after admission. Rate ratios (RRs) comparing the slopes of the adjusted survival curves were calculated using the Mantel-Cox method. RESULTS A total of 192,488 young trauma patients were identified with complete data. Increased hazard of death was seen in patients who were uninsured (hazard ratio [HR]=1.69, 95% confidence interval [CI]=1.59-1.80, p<0.001), of a minority ethnicity (HR=1.08, 95% CI=1.01-1.15, p=0.025) or men (HR=1.14, 95% CI=1.04-1.23, p=0.004). RRs were significantly larger between insurance status (RR=1.75, 95% CI=1.58-1.94, p<0.001) than between race (RR=1.23, 95% CI=1.10-1.37, p<0.001) or between gender (RR=1.16, 95% CI=1.01-1.32, p=0.030). CONCLUSION Risk of death on the first hospital day after injury differs by insurance status, and this disparity becomes more pronounced throughout the hospital stay. Further study is necessary to determine whether this is a result of additional unmeasured patient covariates with insurance status or a difference in provider behavior in response to patient insurance status.
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Socioeconomic Impacts on Survival Differ by Race/Ethnicity among Adolescents and Young Adults with Non-Hodgkin's Lymphoma. J Cancer Epidemiol 2010; 2010:824691. [PMID: 20652048 PMCID: PMC2905919 DOI: 10.1155/2010/824691] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/15/2010] [Indexed: 11/29/2022] Open
Abstract
Shorter survival has been associated with low socioeconomic status (SES) among elderly non-Hodgkin's lymphoma (NHL) patients; however it remains unknown whether the same relationship holds for younger patients. We explored the California Cancer Registry (CCR), to investigate this relationship in adolescent and young adult (AYA) NHL patients diagnosed from 1996 to 2005. A case-only survival analysis was conducted to examine demographic and clinical variables hypothesized to be related to survival. Included in the final analysis were 3,489 incident NHL cases. In the multivariate analyses, all-cause mortality (ACM) was higher in individuals who had later stage at diagnosis (P < .05) or did not receive first-course chemotherapy (P < .05). There was also a significant gradient decrease in survival, with higher ACM at each decreasing quintile of SES (P < .001). Overall results were similar for lymphoma-specific mortality. In the race/ethnicity stratified analyses, only non-Hispanic Whites (NHWs) had a significant SES-ACM trend (P < .001). Reduced overall and lymphoma-specific survival was associated with lower SES in AYAs with NHL, although a significant trend was only observed for NHWs.
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