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Among children with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, those who live in high-poverty areas are substantially more likely to suffer early relapse than other patients, despite having received the same treatment, according to new research from Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. The findings, published today in the journal Pediatric Blood & Cancer, are significant because ALL that relapses early is more difficult to successfully treat.
Although an emerging body of research finds that children from low-income families have lower rates of overall survival than other children with ALL, this study is among the first to explore possible factors contributing to outcome disparities among children who received uniform treatment.
Investigators examined outcomes for 575 children, age 1-18, with newly diagnosed ALL who were treated on Dana-Farber Cancer Institute ALL Consortium Protocols at seven major academic medical centers in the United States between 2000 and 2010. Using US Census Bureau criteria, they defined high-poverty areas as zip codes where 20 percent or more of residents have incomes below the federal poverty level. For a family of four, this translates to an annual income of $24,250 or less.
“These children are getting the same best possible care at well-resourced institutions from highly trained clinicians, and we’re still seeing disparities,” said lead researcher Kira Bona, MD, MPH, a pediatric oncologist at Dana-Farber/Boston Children’s. “In trying to improve cure rates, we, as a field, have focused almost exclusively on biology. If we want to move forward, we also have to look at social determinants.
“In this country, 20 percent of children live in poverty,” Bona added. “Furthermore, we know that the costs of having a child treated for cancer force higher-income families into poverty. If we can devise successful interventions, that’s at least 20 percent of children with cancer whose outcomes we can potentially impact. Any 'moon shot' to cure cancer must include interventions that target socio-economic disparities in outcomes."
Among the study’s findings:
Bona and her colleagues are now undertaking further research designed to delve deeper into the relationship between socio-economic status and outcomes and to allow for the development of poverty-targeted interventions.
“Doing these next two studies is incredibly important,” Bona said. “This study told us that simply providing the current best treatment regimen is not good enough if our goal is to cure every child with cancer. At the same time that we develop new drugs and new treatment protocols, we need to address social determinants of health. Findings from these next studies will help us develop specific interventions to address disparities in outcomes. That’s an amazing opportunity.”
The research was supported by grants from the St. Baldrick’s Foundation, National Palliative Care Research Center and Pablove Foundation. The DFCI ALL Consortium trials 00-001 and 05-001 were supporting by NIH P01 grant 5PO1CA68484.