1
|
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.
Collapse
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
| |
Collapse
|
2
|
Stall M, Germann JN, Orta M, Winick N, Kaye EC. Equitable communication for pediatric cancer patients and families who speak languages other than English. Pediatr Blood Cancer 2024; 71:e30828. [PMID: 38146021 PMCID: PMC10831864 DOI: 10.1002/pbc.30828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Melanie Stall
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Julie N. Germann
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
- Children’s Medical Center Dallas, Department of Psychiatry, Dallas, TX, USA
| | - Martin Orta
- Children’s Medical Center Dallas, Department of Language Access Services, Dallas, TX, USA
| | - Naomi Winick
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Department of Oncology, Memphis, TN, USA
| |
Collapse
|
3
|
Smith SM, Teer A, Tolamatl Ariceaga E, Billman E, Benedict C, Goyal A, Pang EM, Pecos-Duarte C, Lewinsohn R, Smith M, Boynton H, Montes S, Rivera E, Ramirez D, Schapira L. A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region. Pediatr Blood Cancer 2024; 71:e30798. [PMID: 38053230 DOI: 10.1002/pbc.30798] [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: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. PROCEDURE We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15 years old, ≥5 years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. RESULTS Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. CONCLUSIONS Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.
Collapse
Affiliation(s)
- Stephanie M Smith
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anmol Teer
- UC Berkeley School of Public Health, Berkeley, California, USA
| | | | - Elle Billman
- Stanford University School of Medicine, Stanford, California, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anju Goyal
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily M Pang
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Pecos-Duarte
- Stanford University School of Medicine, Stanford, California, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca Lewinsohn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Sandy Montes
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Esmeralda Rivera
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Daniela Ramirez
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|