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Umaretiya PJ, Naranjo A, Zhang FF, Irwin MS, DuBois SG, Bagatell R, Bona K. Enrollment on upfront high-risk neuroblastoma trials by race, ethnicity, and poverty status: A report from the Children's Oncology Group. Pediatr Blood Cancer 2024; 71:e31051. [PMID: 38706187 PMCID: PMC11116035 DOI: 10.1002/pbc.31051] [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: 03/05/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
It is not clear whether trial access disparities exist in the Children's Oncology Group (COG). Here, we leverage a cohort of children with high-risk neuroblastoma (HR-NBL) enrolled on the COG ANBL00B1 neuroblastoma biology study to examine subsequent enrollment to upfront COG therapeutic trials by race, ethnicity, and proxied poverty status. Among 1917 children with HR-NBL enrolled on ANBL00B1, 696 (36.3%) subsequently enrolled on an upfront therapeutic trial with no difference by race, ethnicity, or proxied poverty status. In neuroblastoma, trial access disparities are not comparable to adult oncology, and efforts to advance equity should prioritize other mechanisms of survival disparities.
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Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Arlene Naranjo
- Children’s Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, FL
| | - Fan F. Zhang
- Children’s Oncology Group Statistics and Data Center, Monrovia, CA
| | - Meredith S. Irwin
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Steven G. DuBois
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Division of Pediatric Hematology/Oncology, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rochelle Bagatell
- Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Division of Pediatric Hematology/Oncology, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
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2
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Newman H, Jones E, Li Y, Umaretiya PJ, Wolfson JA, Wolfe J, Bona K. Providing Groceries and Transportation to Poverty-Exposed Pediatric Oncology Families: The PediCARE Pilot Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2412890. [PMID: 38819828 DOI: 10.1001/jamanetworkopen.2024.12890] [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] [Indexed: 06/01/2024] Open
Abstract
This randomized clinical trial evaluates the Pediatric Cancer Resource Equity (PediCARE) intervention, which provided groceries and transportation, vs usual care, for poverty-exposed pediatric oncology families.
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Affiliation(s)
- Haley Newman
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily Jones
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Yimei Li
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Puja J Umaretiya
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Julie A Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Boston
- Department of Pediatrics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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3
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Williams KM, Dougherty D, Plagens C, Shah NR, Tubbs D, Ehrlich PF. Limited English Proficiency can Negatively Impact Disease/Treatment in Children With Cancer Compared to Those Who are English Proficient-an Institutional Study. J Pediatr Surg 2024; 59:800-803. [PMID: 38388287 DOI: 10.1016/j.jpedsurg.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In 2013, 25.5 million people in the United States self-identified as having limited English proficiency (LEP). LEP in adults has been associated with longer hospital stays, increased adverse events, increased emergency room visits, and decreased understanding of medications prescribed. This study aims to define the relationship between LEP and outcomes in a pediatric oncologic population. METHODS We performed a matched case-control study utilizing data from our institutional cancer database (children = 18, 2012-2021). LEP families were matched by disease and stage with English proficient (EP) families. Descriptive, univariate, and bivariate analysis were performed. RESULTS Twenty-four LEP children were identified and matched with 77 EP children. LEP children represented 11 languages, with the most common being Spanish (42%). Statistical regression demonstrated a clinically significant trend for LEP children to have an increased mean number of unexpected hospital admissions (p = 0.04), increased number of clinic cancellations (n = 0.003), and increased emergency department visits (p = 0.05). LEP children were more likely to have Medicaid than commercial insurance (p < 0.001). There was no difference in 2-year event free or overall survival. CONCLUSION In our study cohort, LEP families are at risk for more negative treatment experiences than EP families. Further studies are needed to delineate specific causes and interventions. TYPE OF STUDY Retrospective comparative cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Keyonna M Williams
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA.
| | - Danielle Dougherty
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Connor Plagens
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Nikhil R Shah
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Darrell Tubbs
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Peter F Ehrlich
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
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Newman H, Li Y, Huang YV, Elgarten CW, Myers RM, Ruiz J, Zheng DJ, Leahy AB, Aftandilian C, Arnold SD, Bona K, Gramatges MM, Heneghan MB, Maloney KW, Modi AJ, Mody RJ, Morgan E, Rubnitz J, Winick N, Wilkes JJ, Seif AE, Fisher BT, Aplenc R, Getz KD. Household income and health-related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research. Cancer Med 2024; 13:e6966. [PMID: 38572962 PMCID: PMC10993703 DOI: 10.1002/cam4.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Examine the influence of household income on health-related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML). DESIGN Secondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States. EXPOSURE Household income was self-reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity. OUTCOME Caregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey. RESULT Children with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2-20.2). Seven percent of enrolled patients presented with high acuity (ICU-level care in the first 72 h), and 16% had high toxicity (any ICU-level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction. CONCLUSIONS While primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.
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Affiliation(s)
- Haley Newman
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yimei Li
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuan‐Shung V. Huang
- Department of Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Caitlin W. Elgarten
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Regina M. Myers
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jenny Ruiz
- Division of Hematology‐Oncology, Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel J. Zheng
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Alison Barz Leahy
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Catherine Aftandilian
- Division of Pediatric Hematology‐Oncology, Stem Cell Transplant and Regenerative Medicine, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | - Staci D. Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaEmory University School of MedicineAtlantaGeorgiaUSA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - M. Monica Gramatges
- Division of Pediatric Hematology‐Oncology, Department of PediatricsTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Mallorie B. Heneghan
- Division of Pediatric Hematology‐Oncology, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kelly W. Maloney
- Department of Pediatrics‐Hematology/Oncology and Bone Marrow Transplant, University of Colorado Cancer CenterChildren's Hospital ColoradoAuroraColoradoUSA
| | - Arunkumar J. Modi
- Division of Hematology Oncology, Department of PediatricsUniversity of Arkansas for Medical Sciences, Arkansas Children's HospitalLittle RockArkansasUSA
| | - Rajen J. Mody
- Department of PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elaine Morgan
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey Rubnitz
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Naomi Winick
- Department of Pediatric Hematology OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jennifer J. Wilkes
- Division of Cancer and Blood Disorders, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Alix E. Seif
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brian T. Fisher
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Division of Infectious Disease, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Richard Aplenc
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kelly D. Getz
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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MCCONNELL MARGARET, AGARWAL SUMIT, HANSON ERIKA, MCCRADY ERIN, PARKER MARGARETG, BONA KIRA. Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings. Milbank Q 2024; 102:64-82. [PMID: 37994263 PMCID: PMC10938935 DOI: 10.1111/1468-0009.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.
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Affiliation(s)
| | | | - ERIKA HANSON
- Center for Health Law and Policy Innovation, Harvard Law School
| | - ERIN MCCRADY
- Center for Health Law and Policy Innovation, Harvard Law School
| | - MARGARET G. PARKER
- Child Health Equity CenterUniversity of Massachusetts Chan Medical School
| | - KIRA BONA
- Harvard Medical School
- Dana‐Farber Cancer Institute
- Boston Children's Hospital
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Ohlsen TJD, Martos MR, Hawkins DS. Recent advances in the treatment of childhood cancers. Curr Opin Pediatr 2024; 36:57-63. [PMID: 37966889 DOI: 10.1097/mop.0000000000001310] [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] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Although cancer remains the leading nonaccidental cause of mortality in children, substantial advances in care have led to 5-year overall survival exceeding 85%. However, improvements in outcomes have not been uniform across malignancies or strata of social determinants of health. The current review highlights recent areas of advancement and anticipated directions for future progress. RECENT FINDINGS Incorporation of rational targeted agents into upfront treatment regimens has led to incremental improvements in event-free survival for many children, sometimes with potential reductions in late effects. For rare or challenging-to-treat cancers, the increasing feasibility of molecular profiling has provided specific treatment options to patients with some of the greatest needs. Simultaneously, increased focus is being given to patient-reported outcomes and social determinants of health, the importance ofwhich are becoming readily recognized in providing equitable, quality care. Finally, as survival from malignant diseases improves, breakthroughs in the prevention and management of adverse late effects will promote long-term quality of life. SUMMARY Multi-institutional collaboration and risk-adapted approaches have been crucial to recent advancements in the care of children with cancer and inform potential directions for future investigation.
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Affiliation(s)
- Timothy J D Ohlsen
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Washington, USA
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7
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Campbell K, Siegel DA, Umaretiya PJ, Dai S, Heczey A, Lupo PJ, Schraw JM, Thompson TD, Scheurer ME, Foster JH. A comprehensive analysis of neuroblastoma incidence, survival, and racial and ethnic disparities from 2001 to 2019. Pediatr Blood Cancer 2024; 71:e30732. [PMID: 37867409 PMCID: PMC11018254 DOI: 10.1002/pbc.30732] [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: 08/22/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND We characterize the incidence and 5-year survival of children and adolescents with neuroblastoma stratified by demographic and clinical factors based on the comprehensive data from United States Cancer Statistics (USCS) and the National Program of Cancer Registries (NPCR). METHODS We analyzed the incidence of neuroblastoma from USCS (2003-2019) and survival data from NPCR (2001-2018) for patients less than 20 years old. Incidence trends were calculated by average annual percent change (AAPC) using joinpoint regression. Differences in relative survival were estimated comparing non-overlapping confidence intervals (CI). RESULTS We identified 11,543 primary neuroblastoma cases in USCS. Age-adjusted incidence was 8.3 per million persons [95% CI: 8.2, 8.5], with an AAPC of 0.4% [95% CI: -0.1, 0.9]. Five-year relative survival from the NPCR dataset (n = 10,676) was 79.7% [95% CI: 78.9, 80.5]. Patients aged less than 1 year had the highest 5-year relative survival (92.5%). Five-year relative survival was higher for non-Hispanic White patients (80.7%) or Hispanic patients (80.8%) compared to non-Hispanic Black patients (72.6%). CONCLUSION Neuroblastoma incidence was stable during 2003-2019. Differences in relative survival exist by sex, age, race/ethnicity, and stage; patients who were male, older, non-Hispanic Black, or with distant disease had worse survival. Future studies could seek to assess the upstream factors driving disparities in survival, and evaluate interventions to address inequities and improve survival across all groups.
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Affiliation(s)
- Kevin Campbell
- Division of Hematology-Oncology and Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - David A. Siegel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Puja J. Umaretiya
- Division of Hematology-Oncology and Bone Marrow Transplantation, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shifan Dai
- Cyberdata Technologies, Inc., Herndon, Virginia, USA
| | - Andras Heczey
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas, USA
| | - Philip J. Lupo
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremy M. Schraw
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Trevor D. Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael E. Scheurer
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer H. Foster
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas, USA
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8
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Oesterheld J, Ferguson W, Kraveka JM, Bergendahl G, Clinch T, Lorenzi E, Berry D, Wada RK, Isakoff MS, Eslin DE, Brown VI, Roberts W, Zage P, Harrod VL, Mitchell DS, Hanson D, Saulnier Sholler GL. Eflornithine as Postimmunotherapy Maintenance in High-Risk Neuroblastoma: Externally Controlled, Propensity Score-Matched Survival Outcome Comparisons. J Clin Oncol 2024; 42:90-102. [PMID: 37883734 PMCID: PMC10730038 DOI: 10.1200/jco.22.02875] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/12/2023] [Accepted: 08/18/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Long-term survival in high-risk neuroblastoma (HRNB) is approximately 50%, with mortality primarily driven by relapse. Eflornithine (DFMO) to reduce risk of relapse after completion of immunotherapy was investigated previously in a single-arm, phase II study (NMTRC003B; ClinicalTrials.gov identifier: NCT02395666) that suggested improved event-free survival (EFS) and overall survival (OS) compared with historical rates in a phase III trial (Children Oncology Group ANBL0032; ClinicalTrials.gov identifier: NCT00026312). Using patient-level data from ANBL0032 as an external control, we present new analyses to further evaluate DFMO as HRNB postimmunotherapy maintenance. PATIENTS AND METHODS NMTRC003B (2012-2016) enrolled patients with HRNB (N = 141) after standard up-front or refractory/relapse treatment who received up to 2 years of continuous treatment with oral DFMO (750 ± 250 mg/m2 twice a day). ANBL0032 (2001-2015) enrolled patients with HRNB postconsolidation, 1,328 of whom were assigned to dinutuximab (ch.14.18) treatment. Selection rules identified 92 NMTRC003B patients who participated in (n = 87) or received up-front treatment consistent with (n = 5) ANBL0032 (the DFMO/treated group) and 852 patients from ANBL0032 who could have been eligible for NMTRC003B after immunotherapy, but did not enroll (the NO-DFMO/control group). The median follow-up time for DFMO/treated patients was 6.1 years (IQR, 5.2-7.2) versus 5.0 years (IQR, 3.5-7.0) for NO-DFMO/control patients. Kaplan-Meier and Cox regression compared EFS and OS for overall groups, 3:1 (NO-DFMO:DFMO) propensity score-matched cohorts balanced on 11 baseline demographic and disease characteristics with exact matching on MYCN, and additional sensitivity analyses. RESULTS DFMO after completion of immunotherapy was associated with improved EFS (hazard ratio [HR], 0.50 [95% CI, 0.29 to 0.84]; P = .008) and OS (HR, 0.38 [95% CI, 0.19 to 0.76]; P = .007). The results were confirmed with propensity score-matched cohorts and sensitivity analyses. CONCLUSION The externally controlled analyses presented show a relapse risk reduction in patients with HRNB treated with postimmunotherapy DFMO.
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Affiliation(s)
| | - William Ferguson
- Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St Louis, MO
| | - Jacqueline M. Kraveka
- MUSC Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC
- Division of Pediatric Hematology-Oncology, Hollings Cancer Center, Charleston, SC
| | - Genevieve Bergendahl
- Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, PA
| | - Thomas Clinch
- Biometrics and Clinical Development, USWM, LLC, Louisville, KY
| | | | - Don Berry
- Berry Consultants, Austin, TX
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Austin, TX
| | | | - Michael S. Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | | | - Valerie I. Brown
- Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, PA
| | - William Roberts
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, CA
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, CA
| | - Peter Zage
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, CA
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, CA
| | - Virginia L. Harrod
- Dell Children's Medical Center, University of Texas Dell Medical School, Austin, TX
| | - Deanna S. Mitchell
- Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, MI
| | - Derek Hanson
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
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9
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Chennakesavalu M, Pudela C, Applebaum MA, Lee SM, Che Y, Naranjo A, Park JR, Volchenboum SL, Henderson TO, Cohn SL, Desai AV. Persistence of Racial and Ethnic Disparities in Risk and Survival for Patients with Neuroblastoma over Two Decades. EJC PAEDIATRIC ONCOLOGY 2023; 2:100022. [PMID: 38213818 PMCID: PMC10783478 DOI: 10.1016/j.ejcped.2023.100022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Racial/ethnic survival disparities in neuroblastoma were first reported more than a decade ago. We sought to investigate if these disparities have persisted with current era therapy. METHODS Two patient cohorts were identified in the International Neuroblastoma Risk Group Data Commons (INRGdc) (Cohort 1: diagnosed 2001-2009, n=4359; Cohort 2: diagnosed 2010-2019, n=4891). Chi-squared tests were used to assess the relationship between race/ethnicity and clinical and biologic features. Survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression analyses were performed to investigate the association between racial/ethnic groups and prognostic markers. RESULTS Significantly higher 5-year event-free survival (EFS) and overall survival (OS) were observed for Cohort 2 compared to Cohort 1 (P<0.001 and P<0.001, respectively). Compared to White patients, Black patients in both cohorts had a higher proportion of high-risk disease (Cohort 1: P<0.001; Cohort 2: P<0.001) and worse EFS (Cohort 1: P<0.001; Cohort 2 P<0.001) and OS (Cohort 1: P<0.001; Cohort 2: P<0.001). In Cohort 1, Native Americans also had a higher proportion of high-risk disease (P=0.03) and inferior EFS/OS. No significant survival disparities were observed for low- or intermediate-risk patients in either cohort or high-risk patients in Cohort 1. Hispanic patients with high-risk disease in Cohort 2 had significantly inferior OS (P=0.047). Significantly worse OS, but not EFS, (P=0.006 and P=0.02, respectively) was also observed among Black and Hispanic patients assigned to receive post-Consolidation dinutuximab on clinical trials (n=885). CONCLUSION Racial/ethnic survival disparities have persisted over time and were observed among high-risk patients assigned to receive post-Consolidation dinutuximab.
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Affiliation(s)
| | - Caileigh Pudela
- MedStar Georgetown University Hospital, Washington, D.C., USA
| | | | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Yan Che
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Arlene Naranjo
- Children’s Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Julie R. Park
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | - Susan L. Cohn
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Ami V. Desai
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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10
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Leraas H, Moya-Mendez M, Donohue V, Kawano B, Olson L, Sekar A, Robles J, Wagner L, Greenup R, Haines KL, Tracy E. Using Crowdfunding Campaigns to Examine Financial Toxicity and Logistical Burdens Facing Families of Children With Wilms Tumor. J Surg Res 2023; 291:640-645. [PMID: 37542779 DOI: 10.1016/j.jss.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/10/2023] [Accepted: 07/01/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Treatment for pediatric solid tumors is often intense and multidisciplinary and can create a substantial financial burden for families. Assessing these burdens, termed the financial toxicity of treatment, can be difficult. Using Wilms tumor as an example, we evaluated crowdfunding campaigns in an attempt to better understand the impact of economic and logistic challenges associated with pediatric solid tumor care and identify features associated with successful fundraising with this method. METHODS We used a webscraping algorithm to identify crowdfunding campaigns on GoFundMe.com for pediatric patients with Wilms tumor in the United States. We conducted a cross-sectional analysis to describe the patients and families seeking crowdfunding support for cancer care. After fundraizing information was extracted using the webscraping algorithm, each fundraiser was verified and examined by two independent reviewers to assess demographic, qualitative, disease, and treatment variables. Successful fundraisers, defined as those meeting stated financial goals, were compared to unsuccessful campaigns to identify variables associated with successful crowdfunding campaigns. RESULTS We identified 603 children with Wilms tumor and an associated crowdfunding campaign. The median age was 4 y. The majority lived in two-parent households (68.5%). Patients mentioned siblings in 35.5% of fundraisers. While motivations for crowdfunding varied, hardships endured by families included loss of employment (52.2%), need for childcare for other children (9.8%), direct costs of care [co-payments, insurance, pharmaceuticals, out-of-pocket care costs, etc.] (80.9%), indirect costs associated with seeking care [transportation, parking, lodging, lost opportunity cost, etc.] (56.2%), and need for relocation to pursue complex cancer care (6.8%). Disease characteristics in this cohort were limited to self-reports by families. However, fundraisers mentioned disease characteristics, including tumor stage (47.6%), size (11.4%), positive nodal status (9.6%), metastatic disease (3.6%), pathology (11.8%), upstaging (4.6%), and disease recurrence (8.6%). No individually examined demographic, support, disease, or hardship-related factors varied significantly between successful and unsuccessful crowdfunding campaigns (all P > 0.05). However, successful campaigns requested less money ($11,783.25 successful versus $22,442.2 unsuccessful, <0.001), received more money ($16,409.5 successful vs 7427.4 unsuccessful, P < 0.001), and solicited larger donor numbers (170.3 successful versus 86.3 unsuccessful, P < 0.001). CONCLUSIONS Families whose children undergo multimodal cancer care have significant expenses and burdens and can use crowdfunding to support their costs. Careful consideration of the financial and logistic strains associated with pediatric solid tumor treatment, including thorough analysis of crowdfunding sites, may support better understanding of nonclinical burdens, supporting therapeutic relationships and patient outcomes.
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Affiliation(s)
- Harold Leraas
- M.D., Duke University Department of Surgery, Durham, North Carolina.
| | | | | | - Brad Kawano
- Department of Surgery, University of California San Diego, San Diego, California
| | - Lindsay Olson
- Duke University School of Medicine, Durham, North Carolina
| | - Akshaya Sekar
- Campbell University School of Osteopathic Medicine, Harnett County, North Carolina
| | - Joanna Robles
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Lars Wagner
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Rachel Greenup
- M.D., Duke University Department of Surgery, Durham, North Carolina; Yale University Department of Surgery, New Haven, Connecticut
| | - Krista L Haines
- M.D., Duke University Department of Surgery, Durham, North Carolina
| | - Elisabeth Tracy
- M.D., Duke University Department of Surgery, Durham, North Carolina
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11
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Cupit-Link M, Federico SM. Treatment of High-Risk Neuroblastoma with Dinutuximab and Chemotherapy Administered in all Cycles of Induction. Cancers (Basel) 2023; 15:4609. [PMID: 37760578 PMCID: PMC10527563 DOI: 10.3390/cancers15184609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Administration of chemoimmunotherapy using concurrent chemotherapy and an anti-GD2 monoclonal antibody (mAb), dinutuximab (DIN), demonstrated efficacy for the treatment of relapsed and refractory neuroblastoma. Chemoimmunotherapy, using a humanized anti-GD2 mAb, demonstrated a signal of activity in a phase 2 study for the treatment of patients with newly diagnosed high-risk neuroblastoma (HRNBL). In this single-institution retrospective study, patients with HRNBL received an Induction chemotherapy regimen plus DIN in all Induction cycles. Toxicity and response data were abstracted from the electronic medical record. Toxicities were graded by CTCAE v.5.0. The end of Induction (EOI) objective response rate was determined using the Revised International Neuroblastoma Response Criteria. Twenty-seven patients with HRNBL (23 newly diagnosed, 16 females, median age 3.9 years) started Induction chemoimmunotherapy from 27 January 2017 to 28 December 2022. All patients received DIN with all cycles of Induction therapy, and all but one patient completed Induction therapy. The most common non-hematologic grade ≥ 3 toxicities included fever (44%), hypoxemia (20%), and hypoalbuminemia (11%). End of Induction responses included eighteen with a complete response (CR), seven with a partial response (PR), one with progressive disease (PD), and zero with a minor response or stable disease. Twenty-six of twenty-seven patients (96%) completed all Induction cycles and were evaluable for a response. The EOI response of PR or better in the evaluable cohort was 96%. Dinutuximab was well tolerated with all Induction cycles, demonstrated an encouraging EOI response rate, and should be evaluated in a randomized study.
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12
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Bagatell R, DuBois SG, Naranjo A, Belle J, Goldsmith KC, Park JR, Irwin MS. Children's Oncology Group's 2023 blueprint for research: Neuroblastoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30572. [PMID: 37458162 PMCID: PMC10587593 DOI: 10.1002/pbc.30572] [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: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Neuroblastoma is the most common extra-cranial solid tumor in children and is known for its clinical heterogeneity. A greater understanding of the biology of this disease has led to both improved risk stratification and new approaches to therapy. Outcomes for children with low and intermediate risk disease are excellent overall, and efforts to decrease therapy for such patients have been largely successful. Although survival has improved over time for patients with high-risk disease and treatments evaluated in the relapse setting are now being moved into earlier phases of treatment, much work remains to improve survival and decrease therapy-related toxicities. Studies of highly annotated biobanked samples continue to lead to important insights regarding neuroblastoma biology. Such studies, along with correlative biology studies incorporated into therapeutic trials, are expected to continue to provide insights that lead to new and more effective therapies. A focus on translational science is accompanied by an emphasis on new agent development, optimized risk stratification, and international collaboration to address questions relevant to molecularly defined subsets of patients. In addition, the COG Neuroblastoma Committee is committed to addressing the patient/family experience, mitigating late effects of therapy, and studying social determinants of health in patients with neuroblastoma.
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Affiliation(s)
- Rochelle Bagatell
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven G DuBois
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Arlene Naranjo
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jen Belle
- Children's Oncology Group, Monrovia, California, USA
| | - Kelly C Goldsmith
- Department of Pediatrics, Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Julie R Park
- Department of Oncology, St Jude Children's Research Hospital Department of Oncology, Memphis, Tennessee, USA
| | - Meredith S Irwin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
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13
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Hawkins DS, Gore L. Children's Oncology Group's 2023 blueprint for research. Pediatr Blood Cancer 2023; 70 Suppl 6:e30569. [PMID: 37433635 PMCID: PMC10529891 DOI: 10.1002/pbc.30569] [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: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Douglas S. Hawkins
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Lia Gore
- Department of Pediatrics, University of Colorado School of Medicine and Center for Cancer and Blood Disorders, Children’s Hospital Colorado,, Aurora, CO
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14
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Winestone LE, Beauchemin M, Bona K, Kahn J, Prasad P, Robles JM, Velez MC. Children's Oncology Group's 2023 blueprint for research: Diversity and health disparities. Pediatr Blood Cancer 2023; 70 Suppl 6:e30592. [PMID: 37501542 PMCID: PMC10645477 DOI: 10.1002/pbc.30592] [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: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
The Children's Oncology Group (COG) Diversity and Health Disparities Committee's (DHDC's) mission is to guarantee the highest standard of care for children and adolescents and young adults (AYA) with cancer regardless of ethnic, racial, gender, or socioeconomic background. We strive to identify and address issues of disparity within the existing scientific structure of COG and to support research across COG to improve survival by ensuring equitable access to COG-sponsored clinical trials. We are committed to advance COG-led research identifying mechanistic drivers of disparities and, concurrently, evaluating interventions to alleviate disparities in the COG trial setting. As trials identify the most promising therapies, diverse representation is critical to ensure that findings are relevant to everyone. Factors impacting clinical trial participation among vulnerable populations are complex, consisting of barriers at societal, systems, and individual levels. Recent efforts by investigators within DHDC demonstrated that trial-embedded collection of family-reported sociodemographic data and social determinants of health (SDoH) is feasible and acceptable in the context of COG. Diversity in the pediatric oncology workforce is essential and one potential approach to improving representation on clinical trials. To support and retain diverse oncology providers and researchers, a Minority Young Investigator Award (MYIA) was created to facilitate opportunities for graduating trainees and YIs with an interest in childhood cancer disparities research within COG. Although there are challenges to achieve the DHDC's priorities, only through collaboration and support for this work we will be able to elucidate mechanisms underlying inferior survival outcomes for historically marginalized children and AYA, and more importantly, implement interventional investigation to improve outcomes.
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Affiliation(s)
- Lena E. Winestone
- Division of Allergy, Immunology, and BMT, Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Melissa Beauchemin
- Columbia University School of Nursing, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Justine Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Pinki Prasad
- Hematology-Oncology Division, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital New Orleans, New Orleans, LA
| | - Joanna M. Robles
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC
| | - Maria C. Velez
- Hematology-Oncology Division, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital New Orleans, New Orleans, LA
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15
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Krystal J, Foster JH. Treatment of High-Risk Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1302. [PMID: 37628301 PMCID: PMC10453838 DOI: 10.3390/children10081302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
High-risk neuroblastoma is a highly aggressive solid tumor that most commonly presents in early childhood. Advances in treatment through decades of clinical trials and research have led to improved outcomes. This review provides an overview of the current state of treatment for high-risk neuroblastoma.
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Affiliation(s)
- Julie Krystal
- Zucker Hofstra School of Medicine, Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA
| | - Jennifer H. Foster
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Cancer Center, Houston, TX 77030, USA;
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16
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Wadhwa A, Chen Y, Hageman L, Hoppmann A, Angiolillo A, Dickens DS, Neglia JP, Ravindranath Y, Ritchey AK, Termuhlen A, Wong FL, Landier W, Bhatia S. Poverty and relapse risk in children with acute lymphoblastic leukemia: a Children's Oncology Group study AALL03N1 report. Blood 2023; 142:221-229. [PMID: 37070673 PMCID: PMC10375268 DOI: 10.1182/blood.2023019631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/19/2023] Open
Abstract
The association between individual-level poverty and relapse in children receiving maintenance treatment for acute lymphoblastic leukemia (ALL) remains unclear. In a secondary analysis of COG-AALL03N1, we used data from US Census Bureau to categorize patients living below year-specific federal poverty thresholds, calculated using self-reported annual household income and size of household. Participants with federal poverty thresholds above 120% of their yearly household income were categorized as living in extreme poverty. Hazard of relapse was estimated using multivariable proportional subdistributional hazards regression for patients living in extreme poverty while receiving ALL maintenance therapy after adjusting for relevant predictors. Among 592 patients in this analysis, 12.3% of the patients were living in extreme poverty. After a median follow-up of 7.9 years, the cumulative incidence of relapse at 3 years from study enrollment among those living in extreme poverty was significantly higher (14.3%) than those not living in extreme poverty (7.6%). Multivariable analysis demonstrated that children living in extreme poverty had a 1.95-fold greater hazard of relapse than those not living in extreme poverty; this association was mitigated after the inclusion of race/ethnicity in the model, likely because of collinearity between race/ethnicity and poverty. A greater proportion of children living in extreme poverty were nonadherent to mercaptopurine (57.1% vs 40.9%); however, poor adherence did not completely explain the association between poverty and relapse risk. Future studies need to understand the mechanisms underlying the association between extreme poverty and relapse risk. This trial was registered at www.clinicaltrials.gov as #NCT00268528.
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Affiliation(s)
- Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Anna Hoppmann
- Division of Pediatric Hematology/Oncology, University of South Carolina School of Medicine, Columbia, SC
| | | | - David S. Dickens
- Division of Pediatric Hematology/Oncology, University of Iowa, Iowa City, IA
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | | | - A. Kim Ritchey
- Division of Hematology/Oncology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amanda Termuhlen
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
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17
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Desai AV, Elmuti L, Cahaney C, De Guzman RM, Streby KA, Cohn SL. Multimodality treatment for recurrent neuroblastoma in the central nervous system. Pediatr Blood Cancer 2023; 70:e30227. [PMID: 36720647 DOI: 10.1002/pbc.30227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
Survival for patients with recurrent central nervous system (CNS) neuroblastoma remains poor. A single-institutional study demonstrated the potential of multimodality therapy, including compartmental intrathecal radioimmunotherapy (cRIT) with 131 I-3F8 or 131 I-8H9 to increase the survival of neuroblastoma patients with CNS relapse. However, not all patients are able to receive this therapy. We report three patients with CNS neuroblastoma who remain disease-free 3-9 years after receiving multimodality treatment without cRIT. Additional studies to identify patients most likely to benefit from cRIT are warranted.
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Affiliation(s)
- Ami V Desai
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Lena Elmuti
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Christine Cahaney
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | | | - Keri A Streby
- Department of Pediatrics, The Ohio State University/Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan L Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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18
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Hall AG, Winestone LE, Sullivan EM, Wu Q, Lamble AJ, Walters MC, Aguayo-Hiraldo P, Conde LB, Coker TR, Dornsife D, Keating AK, Merino DM, Ramsey B, Park JR, Agrawal AK. Access to Chimeric Antigen Receptor T Cell Clinical Trials in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult Acute Lymphobastic Leukemia Patients. Transplant Cell Ther 2023:S2666-6367(23)01198-3. [PMID: 36966871 DOI: 10.1016/j.jtct.2023.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is a promising approach to improve survival for children and adults with relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL), but these clinical trials might not be equally accessible to patients of low socioeconomic status (SES) or to patients from racial or ethnic minority groups. We sought to describe the sociodemographic characteristics of pediatric and adolescent and young adult (AYA) patients enrolled in CAR-T clinical trials and to compare these characteristics to those of other patients with r/r B-ALL. We conducted a multicenter retrospective cohort study at 5 pediatric consortium sites to compare the sociodemographic characteristics of patients treated and enrolled in CAR-T trials at their home institution, other patients with r/r B-ALL treated at these sites, and patients referred from an external hospital for CAR-T trials. The patients were age 0 to 27 years with r/r B-ALL treated at 1 of the consortium sites between 2012 and 2018. Clinical and demographic data were collected from the electronic health record. We calculated distance from home to treating institution and assigned SES scores based on census tract. Among the 337 patients treated for r/r B-ALL, 112 were referred from an external hospital to a consortium site and enrolled in a CAR-T trial and 225 were treated primarily at a consortium site, with 34% enrolled in a CAR-T trial. Patients treated primarily at a consortium site had similar characteristics regardless of trial enrollment. Lower proportions of Hispanic patients (37% versus 56%; P = .03), patients whose preferred language was Spanish (8% versus 22%; P = .006), and publicly insured patients (38% versus 65%; P = .001) were referred from an external hospital than were treated primarily at a consortium site and enrolled in a CAR-T trial. Patients who are Hispanic, Spanish-speaking, or publicly insured are underrepresented in referrals from external hospitals to CAR-T centers. External provider implicit bias also may influence referral of these patients. Establishing partnerships between CAR-T centers and external hospital sites may improve provider familiarity, patient referral, and patient access to CAR-T clinical trials.
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Affiliation(s)
- Anurekha G Hall
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Lena E Winestone
- Division of Pediatric Allergy, Immunology, and Blood & Marrow Transplantation, UCSF Benioff Children's Hospitals, San Francisco, California
| | - Erin M Sullivan
- Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington
| | - Qian Wu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Adam J Lamble
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Mark C Walters
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California; USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lourdes Baez Conde
- USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Tumaini R Coker
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington
| | | | - Amy K Keating
- Pediatric Blood and Marrow Transplantation, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Bonnie Ramsey
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Julie R Park
- Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Anurag K Agrawal
- Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California
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19
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Hoppmann AL, Dai C, Daves M, Imran H, Whelan K, Kenzik K, Bhatia S. Persistent Child Poverty and Mortality in a Cohort of Children with Cancer in Alabama. Cancer Epidemiol Biomarkers Prev 2023; 32:380-386. [PMID: 36129811 PMCID: PMC9991934 DOI: 10.1158/1055-9965.epi-22-0353] [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: 03/28/2022] [Revised: 05/27/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND One-fifth of U.S. counties are designated persistent child poverty counties (≥20% of children in poverty since 1980). The association between a persistent child poverty environment and mortality in children with cancer is unknown. METHODS Our cohort includes 2,089 children with cancer (2000-2016) in Alabama. We used multivariable Cox proportional hazards modeling (adjusted for sociodemographics/clinical characteristics) to assess mortality by persistent child poverty designation at 1, 5, and 10 years from diagnosis. Distance to treatment was subsequently explored. RESULTS Forty-two percent of the cohort lived in a persistent child poverty county; they were more likely to be African American (P < 0.0001), have public/no insurance (P = 0.0009), and live >100 miles to treatment (P < 0.0001). Children in persistent child poverty counties were 30% more likely to die by 5 years [95% confidence interval (CI) = 1.06-1.59; P = 0.012]. Distance (per 20-mile increase) to treatment was associated with a 9% increased mortality risk (P < 0.0001). Children with both exposures (distance >100 miles and persistent child poverty) faced the highest mortality risk at 5 years (HR = 1.80; 95% CI = 1.39-2.33; P < 0.0001). In subanalysis, children exposed to persistent child poverty were at higher risk for cancer-related mortality. However, the risk of health-related mortality did not differ. CONCLUSIONS Among children with cancer from the Deep South, persistent child poverty was a prevalent exposure associated with inferior overall survival. Distance to treatment was independently associated with inferior survival. Children with both exposures had the highest risk of mortality. IMPACT Persistent child poverty is associated with inferior survival among children with cancer; mechanisms underlying this disparity warrant investigation. See related commentary by Orjuela-Grimm and Beauchemin, p. 295.
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Affiliation(s)
- Anna L. Hoppmann
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Divsion of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Marla Daves
- St Jude Affiliate Clinic at Huntsville Hospital for Women & Children, Huntsville, AL
| | | | - Kimberly Whelan
- Divsion of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Kelly Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Divsion of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
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20
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Newman H, Li Y, Liu H, Myers RM, Tam V, DiNofia A, Wray L, Rheingold SR, Callahan C, White C, Baniewicz D, Winestone LE, Kadauke S, Diorio C, June CH, Getz KD, Aplenc R, Teachey DT, Maude SL, Grupp SA, Bona K, Leahy AB. Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy. Blood 2023; 141:609-619. [PMID: 36351239 PMCID: PMC9979709 DOI: 10.1182/blood.2022017866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/11/2022] Open
Abstract
Children living in poverty experience excessive relapse and death from newly diagnosed acute lymphoblastic leukemia (ALL). The influence of household poverty and neighborhood social determinants on outcomes from chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory (r/r) leukemia is poorly described. We identified patients with r/r CD19+ ALL/lymphoblastic lymphoma treated on CD19-directed CAR T-cell clinical trials or with commercial tisagenlecleucel from 2012 to 2020. Socioeconomic status (SES) was proxied at the household level, with poverty exposure defined as Medicaid-only insurance. Low-neighborhood opportunity was defined by the Childhood Opportunity Index. Among 206 patients aged 1 to 29, 35.9% were exposed to household poverty, and 24.9% had low-neighborhood opportunity. Patients unexposed to household poverty or low-opportunity neighborhoods were more likely to receive CAR T-cell therapy with a high disease burden (>25%), a disease characteristic associated with inferior outcomes, as compared with less advantaged patients (38% vs 30%; 37% vs 26%). Complete remission (CR) rate was 93%, with no significant differences by household poverty (P = .334) or neighborhood opportunity (P = .504). In multivariate analysis, patients from low-opportunity neighborhoods experienced an increased hazard of relapse as compared with others (P = .006; adjusted hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.3-4.1). There was no difference in hazard of death (P = .545; adjusted HR, 1.2; 95% CI, 0.6-2.4). Among children who successfully receive CAR T-cell therapy, CR and overall survival are equitable regardless of proxied SES and neighborhood opportunity. Children from more advantaged households and neighborhoods receive CAR T-cell therapy with a higher disease burden. Investigation of multicenter outcomes and access disparities outside of clinical trial settings is warranted.
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Affiliation(s)
- Haley Newman
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Regina M. Myers
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amanda DiNofia
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lisa Wray
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Susan R. Rheingold
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Claire White
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Diane Baniewicz
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lena E. Winestone
- Division of Allergy, Immunology, and Blood & Marrow Transplant, Department of Pediatrics, UCSF Benioff Children’s Hospitals, San Francisco, CA
| | - Stephan Kadauke
- Division of Transfusion Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Caroline Diorio
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Carl H. June
- Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA
| | - Kelly D. Getz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Richard Aplenc
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - David T. Teachey
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shannon L. Maude
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stephan A. Grupp
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kira Bona
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Allison Barz Leahy
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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21
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Gupta S, Dai Y, Chen Z, Winestone LE, Teachey DT, Bona K, Aplenc R, Rabin KR, Zweidler-McKay P, Carroll AJ, Heerema NA, Gastier-Foster J, Borowitz MJ, Wood BL, Maloney KW, Mattano LA, Larsen EC, Angiolillo AL, Burke MJ, Salzer WL, Winter SS, Brown PA, Guest EM, Dunsmore KP, Kairalla JA, Winick NJ, Carroll WL, Raetz EA, Hunger SP, Loh ML, Devidas M. Racial and ethnic disparities in childhood and young adult acute lymphocytic leukaemia: secondary analyses of eight Children's Oncology Group cohort trials. Lancet Haematol 2023; 10:e129-e141. [PMID: 36725118 PMCID: PMC9951049 DOI: 10.1016/s2352-3026(22)00371-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have identified racial and ethnic disparities in childhood acute lymphocytic leukaemia survival. We aimed to establish whether disparities persist in contemporaneous cohorts and, if present, are attributable to differences in leukaemia biology or insurance status. METHODS Patients with newly diagnosed acute lymphocytic leukaemia in inpatient and outpatient centres in the USA, Canada, Australia, and New Zealand, aged 0-30 years, who had race or ethnicity data available, enrolled on eight completed Children's Oncology Group trials (NCT00103285, NCT00075725, NCT00408005, NCT01190930, NCT02883049, NCT02112916, NCT02828358, and NCT00557193) were included in this secondary analysis. Race and ethnicity were categorised as non-Hispanic White, Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic other. Event-free survival and overall survival were compared across race and ethnicity groups. The relative contribution of clinical and biological disease prognosticators and insurance status was examined through multivariable regression models, both among the entire cohort and among those with B-cell lineage versus T-cell lineage disease. FINDINGS Between Jan 1, 2004, and Dec 31, 2019, 24 979 eligible children, adolescents, and young adults with acute lymphocytic leukaemia were enrolled, of which 21 152 had race or ethnicity data available. 11 849 (56·0%) were male and 9303 (44·0%) were female. Non-Hispanic White patients comprised the largest racial or ethnic group (13 872 [65·6%]), followed by Hispanic patients (4354 [20·6%]), non-Hispanic Black patients (1517 [7·2%]), non-Hispanic Asian (n=1071 [5·1%]), and non-Hispanic other (n=338 [1·6%]). 5-year event-free survival was 87·4% (95% CI 86·7-88·0%) among non-Hispanic White patients compared with 82·8% (81·4-84·1%; hazard ratio [HR] 1·37, 95% CI 1·26-1·49; p<0·0001) among Hispanic patients and 81·8% (79·3-84·0; HR 1·45, 1·28-1·65; p<0·0001) among non-Hispanic Black patients. Non-hispanic Asian patients had a 5-year event-free survival of 88·1% (95% CI 85·5-90·3%) and non-Hispanic other patients had a survival of 82·8% (76·4-87·6%). Inferior event-free survival among Hispanic patients was substantially attenuated by disease prognosticators and insurance status (HR decreased from 1·37 [1·26-1·49; p<0·0001] to 1·11 [1·00-1·22; p=0·045]). The increased risk among non-Hispanic Black patients was minimally attenuated (HR 1·45 [1·28-1·65; p<0·0001] to 1·32 [1·14-1·52; p<0·0001]). 5-year overall survival was 93·6% (91·5-95·1%) in non-Hispanic Asian patients, 93·3% (92·8-93·7%) in non-Hispanic White patients, 89·9% (88·7-90·9%) in Hispanic, 89·7% (87·6-91·4%) in non-Hispanic Black patients, 88·9% (83·2-92·7%) in non-Hispanic other patients. Disparities in overall survival were wider than event-free survival (eg, among non-Hispanic other patients, the HR for event-free survival was 1·43 [1·10-1·85] compared with 1·74 [1·27-2·40] for overall survival). Disparities were restricted to patients with B-cell acute lymphocytic leukaemia, no differences in event-free survival or overall survival were seen in the T-cell acute lymphocytic leukaemia group. INTERPRETATION Substantial disparities in outcome for B-cell acute lymphocytic leukaemia persist by race and ethnicity, but are not observed in T-cell acute lymphocytic leukaemia. Future studies of relapsed patients, access to and quality of care, and other potential aspects of structural racism are warranted to inform interventions aimed at dismantling racial and ethnic disparities. FUNDING National Cancer Institute and St Baldrick's Foundation.
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Affiliation(s)
- Sumit Gupta
- Cancer Research Program, ICES, Toronto, ON, Canada; Institute for Health Policy, Evaluation and Management and Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Yunfeng Dai
- Biostatistics, University of Florida, Gainesville, FL, USA
| | - Zhiguo Chen
- Biostatistics, University of Florida, Gainesville, FL, USA
| | - Lena E Winestone
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Comprehensive Cancer Centre, University of California, San Francisco, San Francisco, CA, USA
| | - David T Teachey
- Cellular Therapy and Transplant Section and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Richard Aplenc
- Cellular Therapy and Transplant Section and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen R Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Patrick Zweidler-McKay
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA; University of Texas MD Anderson UT Health Graduate School of Biomedical Sciences, Houston, TX, USA; ImmunoGen, Waltham, MA, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - Julie Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, Ohio State University School of Medicine, Columbus, OH, USA
| | | | - Brent L Wood
- Department of Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kelly W Maloney
- Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Eric C Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME, USA
| | - Anne L Angiolillo
- Division of Oncology, Centre for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Michael J Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wanda L Salzer
- US Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
| | - Stuart S Winter
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Erin M Guest
- Genomic Medicine Centre, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kimberley P Dunsmore
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Naomi J Winick
- Simmons Cancer Center and Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William L Carroll
- Department of Pediatrics, NYU Langone Health, New York City, NY, USA
| | - Elizabeth A Raetz
- Department of Pediatrics, NYU Langone Health, New York City, NY, USA
| | - Stephen P Hunger
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Comprehensive Cancer Centre, University of California, San Francisco, San Francisco, CA, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
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22
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Campbell K, Kao PC, Naranjo A, Kamijo T, Ramanujachar R, London WB, DuBois SG. Clinical and biological features prognostic of survival after relapse or progression of INRGSS stage MS pattern neuroblastoma: A report from the International Neuroblastoma Risk Group (INRG) project. Pediatr Blood Cancer 2023; 70:e30054. [PMID: 36316811 PMCID: PMC9988328 DOI: 10.1002/pbc.30054] [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: 07/07/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Outcomes for patients with INRGSS metastatic special (MS) metastatic pattern neuroblastoma at initial diagnosis are well described. Prognosis after an initial event (relapse, progression, secondary malignancy) is unclear. METHODS We investigated characteristics of MS pattern neuroblastoma patients in the International Neuroblastoma Risk Group database who subsequently experienced an event. Post-event overall survival (OS) ± standard error was calculated overall and by diagnosis era: before 2000 versus 2001 or after. Cox models were used to identify factors prognostic of post-event OS. RESULTS Among 209 patients with an event, 88% were less than 365 days old at diagnosis; tumors were MYCN amplified in 24% and diploid in 33%. The median (range) time from diagnosis to first event was 8.16 months (7 days to 11.24 years). Of 96 patients with known relapse/progression pattern, 75% were metastatic or primary plus metastatic. Five-year post-event OS was 53% ± 3.6% and was higher for 2001 and afterwards (62% ± 5.0%) compared to before 2001 (44% ± 4.9%; p = .0046). In patients diagnosed in 2001 and after, older age, Hispanic ethnicity, MYCN amplification, 1p LOH, diploidy, high Mitotic Karyorrhexis Index, high lactate dehydrogenase (LDH), unfavorable histology, and longer time to first event were prognostic of worse post-event OS. Independent adverse prognostic factors on multivariable testing were non-White race, MYCN amplification, and diploidy. SUMMARY Patients diagnosed in and after 2001 have substantially better post-event OS compared to before 2001. In those diagnosed in and after 2001, most well-accepted prognostic factors for OS at diagnosis are also prognostic of post-event OS. Future studies may evaluate strategies to improve outcomes in this rare population.
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Affiliation(s)
- Kevin Campbell
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Pei-Chi Kao
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Arlene Naranjo
- Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida, USA
| | - Takehiko Kamijo
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Ramya Ramanujachar
- Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
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23
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Ohlsen TJD, Doody DR, Mueller BA, Desai AD, Chow EJ. Population-Based Impact of Rurality and Neighborhood-Level Socioeconomic Disadvantage on Pediatric Cancer Mortality in Washington State. Cancer Epidemiol Biomarkers Prev 2023; 32:141-148. [PMID: 36343539 PMCID: PMC9839485 DOI: 10.1158/1055-9965.epi-22-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childhood cancer-related mortality differs by socioeconomic factors, but the impact of residential location, including rurality and neighborhood-level socioeconomic disadvantage, is not well-characterized. METHODS This retrospective cohort study linked Washington State cancer registry data (1992-2013) to state birth (1974-2013) and death records (1992-2013) to identify residents <20 years diagnosed with cancer (n = 4,306). Census-based rural-urban commuting area codes and Area Deprivation Index (ADI) defined rural residence and neighborhood socioeconomic disadvantage at time of cancer diagnosis, respectively. Neighborhoods in the highest state ADI quintile were classified as the most disadvantaged. Kaplan-Meier estimates and Cox hazards models, adjusted for key characteristics, were used to compare mortality by rural and ADI classification. RESULTS Five-year overall survival for children from non-rural low ADI neighborhoods (referent) was 80.9%±0.8%, versus 66.4%±2.9% from non-rural high ADI neighborhoods, 69.4%±3.8% from rural low ADI neighborhoods, and 66.9%±3.8% from rural high ADI neighborhoods (P < 0.01 for each comparison versus referent). Compared with the referent group, children from comparator neighborhoods had a greater mortality risk: Rural low ADI [hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.12-2.02], rural high ADI (HR, 1.53; 95% CI, 1.16-2.01), and non-rural high ADI (HR, 1.64; 95% CI, 1.32-2.04). Associations of ADI and rurality with mortality varied in sub-analyses by cancer type. CONCLUSIONS Children with cancer living in rural and/or socioeconomically disadvantaged neighborhoods at diagnosis experienced greater mortality relative to those without either factor. IMPACT Future investigation is needed to examine how rurality and poverty potentially impact healthcare utilization and health-related outcomes in pediatric oncology.
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Affiliation(s)
- Timothy J. D. Ohlsen
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute,Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - David R. Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Center
| | - Beth A. Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Center,Department of Epidemiology, University of Washington
| | - Arti D. Desai
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - Eric J. Chow
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Public Health Sciences Division, Fred Hutchinson Cancer Center
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24
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Taylor MR, Steineck A, Lahijani S, Hall AG, Jim HSL, Phelan R, Knight JM. Biobehavioral Implications of Chimeric Antigen Receptor T-cell Therapy: Current State and Future Directions. Transplant Cell Ther 2023; 29:19-26. [PMID: 36208728 DOI: 10.1016/j.jtct.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable clinical responses in hematologic malignancies. Recent advances in CAR T-cell therapy have expanded its application into other populations including older patients and those with central nervous system and solid tumors. Although its clinical efficacy has been excellent for some malignancies, CAR T-cell therapy is associated with severe and even life-threatening immune-mediated toxicities, including cytokine release syndrome and neurotoxicity. There is a strong body of scientific evidence highlighting the connection between immune activation and neurocognitive and psychological phenomena. To date, there has been limited investigation into this relationship in the context of immunotherapy. In this review, we present a biobehavioral framework to inform current and future cellular therapy research and contribute to improving the multidimensional outcomes of patients receiving CAR T-cell therapy.
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Affiliation(s)
- Mallory R Taylor
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, Washington; Palliative Care and Resilience Program, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Sheila Lahijani
- Division of Medical Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Anurekha G Hall
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
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25
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Aziz-Bose R, Zheng DJ, Umaretiya PJ, Ilcisin L, Stevenson K, Koch V, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Silverman LB, Wolfe J, Bona K. Feasibility of oncology clinical trial-embedded evaluation of social determinants of health. Pediatr Blood Cancer 2022; 69:e29933. [PMID: 36069432 DOI: 10.1002/pbc.29933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Abstract
Social determinants of health (SDoH) are associated with stark disparities in cancer outcomes, but systematic SDoH data collection is virtually absent from oncology clinical trials. Trial-based SDoH data are essential to ensure representation of marginalized populations, contextualize outcome disparities, and identify health-equity intervention opportunities. We report the feasibility of a pediatric oncology multicenter therapeutic trial-embedded SDoH investigation. Among 448 trial participants, 392 (87.5%) opted-in to the embedded SDoH study; 375 (95.7%) completed baseline surveys, with high longitudinal response rates (88.9-93.1%) over 24 months. Trial-embedded SDoH data collection is feasible and acceptable and must be consistently included within future oncology trials.
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Affiliation(s)
- Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Zheng
- Divisions of Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen Stevenson
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Victoria Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Peter D Cole
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lisa M Gennarini
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Montefiore Medical Center, Bronx, New York, USA
| | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Thai-Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Bruno Michon
- Department of Pediatrics, Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital/Brown University, Providence, Rhode Island, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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26
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Emeny RT, Zhang K, Goodman D, Dev A, Lewinson T, Wolff K, Kerrigan CL, Kraft S. Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease. Curr Protoc 2022; 2:e556. [PMID: 36200800 DOI: 10.1002/cpz1.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.
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Affiliation(s)
- Rebecca T Emeny
- Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Daisy Goodman
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alka Dev
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Terri Lewinson
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kristina Wolff
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Carolyn L Kerrigan
- Medical Director, Patient Reported Outcomes, Dartmouth-Hitchcock, Professor of Surgery, Active Emerita, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Sally Kraft
- Vice President of Population Health, Dartmouth Health, Lebanon, New Hampshire
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Chow EJ, Winestone LE, Lupo PJ, Diller LR, Henderson TO, Kadan-Lottick NS, Levine JM, Ness KK, Bhatia S, Armenian SH. Leveraging Clinical Trial Populations and Data from the Children's Oncology Group for Cancer Survivorship Research. Cancer Epidemiol Biomarkers Prev 2022; 31:1675-1682. [PMID: 35732489 PMCID: PMC9444937 DOI: 10.1158/1055-9965.epi-22-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/22/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents diagnosed with cancer can now expect an average 85% 5-year overall survival, with significant improvements in longer-term morbidity and mortality reported over the past several decades. However, the long-term impact of therapeutic agents and modalities introduced in recent years remains unclear and will require dedicated follow-up in the years ahead. The Children's Oncology Group (COG), a part of the NCI's National Clinical Trials Network, with over 200 sites across North America and beyond, enrolls more than 10,000 patients onto research protocols annually, inclusive of first-line clinical trials and nontherapeutic studies. COG provides a platform to conduct survivorship research with several unique strengths: (i) a huge catchment to ascertain relatively rare but important adverse events, (ii) study populations that are otherwise too rare to study in smaller consortia, including access to highly diverse patient populations, (iii) long-term follow-up of clinical trial populations linked to the original trial data, and (iv) a natural platform for intervention research. Enhancements in COG infrastructure facilitate survivorship research, including a COG patient registry (Project:EveryChild), availability of a long-term follow-up tracking resource, and successful deployment of various remote-based study procedures to reduce the burden on participants and participating institutions.
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Affiliation(s)
- Eric J. Chow
- Fred Hutchinson Cancer Center, University of Washington, Seattle Children’s Hospital, Seattle, WA,Corresponding author: Eric Chow, MD, MPH, Fred Hutchinson Cancer Center, PO Box 19024, M4-C308, Seattle, WA 98109,
| | - Lena E. Winestone
- Benioff Children’s Hospitals, University of California, San Francisco, CA
| | - Philip J. Lupo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Lisa R. Diller
- Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, MA
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Bird N, Scobie N, Palmer A, Ludwinski D. To transplant, or not to transplant? That is the question. A patient advocate evaluation of autologous stem cell transplant in neuroblastoma. Pediatr Blood Cancer 2022; 69:e29663. [PMID: 35373890 DOI: 10.1002/pbc.29663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 12/27/2022]
Abstract
High-dose chemotherapy with autologous stem cell transplant (ASCT) has been a mainstay of high-risk neuroblastoma treatment for several decades, demonstrating improvements in event-free survival but with risks of serious or even life-threatening acute toxicities, severe long-term adverse health effects for survivors, and ongoing contention regarding overall survival benefit. The merits of ASCT in the modern era of immunotherapy are a source of debate among parents, advocates, and some physicians. Here we examine evidence for and against ASCT, explore parent attitudes and their turmoil over decision-making, and strongly encourage international research consortia to develop a coordinated strategy to accelerate progress toward a future that avoids the routine use of ASCT in high-risk neuroblastoma.
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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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30
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Bhutada JKS, Hwang AE, Liu L, Tsai KY, Deapen D, Freyer DR. Survival of Adolescents and Young Adults with Prevalent Poor-Prognosis Metastatic Cancers: A Population-Based Study of Contemporary Patterns and Their Implications. Cancer Epidemiol Biomarkers Prev 2022; 31:900-908. [PMID: 35086824 PMCID: PMC8983591 DOI: 10.1158/1055-9965.epi-21-0913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although survival has improved dramatically for most adolescents and young adults (AYA; 15-39 years old) with cancer, it remains poor for those presenting with metastatic disease. To better characterize this subset, we conducted a landscape survival comparison with older adults (40-79 years). METHODS Using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, we examined incident cases of poor-prognosis metastatic cancers (5-year survival < 50%) among AYAs (n = 11,518) and older adults (n = 345,681) and compared cause-specific survival by sociodemographic characteristics (race/ethnicity, sex, and socioeconomic status). Adjusted HRs (aHR) for death from metastatic disease [95% confidence intervals (95% CI)] were compared between AYAs and older adults (Pint). RESULTS AYAs had significantly better survival than older adults for every cancer site except kidney, where it was equivalent (range of aHRs = 0.91; 95% CI, 0.82-1.02 for kidney cancer to aHR = 0.33; 95% CI, 0.26-0.42 for rhabdomyosarcoma). Compared with their older adult counterparts, greater survival disparities existed for AYAs who were non-Hispanic Black with uterine cancer (aHR = 2.20; 95% CI, 1.25-3.86 versus aHR = 1.40; 95% CI, 1.28-1.54; Pint = 0.049) and kidney cancer (aHR = 1.51; 95% CI, 1.15-1.98 versus aHR = 1.10; 95% CI, 1.03-1.17; Pint = 0.04); non-Hispanic Asian/Pacific Islanders with ovarian cancer (aHR = 1.47; 95% CI, 1.12-1.93 versus aHR = 0.89; 95% CI, 0.84-0.95; Pint<0.001); and males with colorectal cancer (aHR = 1.21; 95% CI, 1.10-1.32 versus aHR = 1.08; 95% CI, 1.06-1.10; Pint = 0.045). CONCLUSIONS AYAs diagnosed with these metastatic cancers have better survival than older adults, but outcomes remain dismal. IMPACT Overcoming the impact of metastasis in these cancers is necessary for continuing progress in AYA oncology. Sociodemographic disparities affecting AYAs within kidney, uterine, ovarian, and colorectal cancer could indicate plausible effects of biology, environment, and/or access and should be explored.
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Affiliation(s)
| | - Amie E. Hwang
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lihua Liu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kai-ya Tsai
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dennis Deapen
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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31
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Umaretiya PJ, Revette A, Seo A, Flamand Y, Ilcisin L, Zheng DJ, Bhatia S, Wolfe J, Bona K. PediCARE: Development of a poverty-targeted intervention for pediatric cancer. Pediatr Blood Cancer 2021; 68:e29195. [PMID: 34190405 PMCID: PMC8384686 DOI: 10.1002/pbc.29195] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poverty is associated with inferior psychosocial outcomes, higher rates of relapse, and decreased overall survival in children with cancer. Despite this, there are few evidence-based, poverty-targeted interventions and none specific to pediatric oncology. To address this gap, we developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention, a household material hardship (HMH) targeted intervention providing transportation and groceries to pediatric oncology families. METHODS This was a single-arm pilot study conducted at a single, large, tertiary pediatric cancer center. Newly diagnosed patients with HMH-exposure were directly assigned to receive PediCARE for a total of three months. Quantitative and qualitative approaches were used to evaluate its acceptability and to rapidly refine the intervention. RESULTS Nine families (100% of those approached) consented to enrollment with no attrition over the three-month study period. Families were highly satisfied with the intervention and recommended participation to others. All of the families utilized the grocery delivery component of PediCARE, and seven utilized the transportation component. Qualitative participant feedback was used to rapidly refine the intervention including logistics of intervention delivery, and dose of intervention components. CONCLUSION PediCARE, a poverty-targeted intervention, was highly acceptable to pediatric oncology families. The intervention was refined in real-time utilizing quantitative and qualitative feedback. Next steps include intervention evaluation in a randomized, controlled feasibility study.
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Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Anna Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Seo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA,Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, MA
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32
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Zheng DJ, Li A, Ma C, Ribeiro KB, Diller L, Bona K, Marron JM. Socioeconomic disparities in survival after high-risk neuroblastoma treatment with modern therapy. Pediatr Blood Cancer 2021; 68:e29127. [PMID: 34022098 PMCID: PMC8384664 DOI: 10.1002/pbc.29127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/18/2021] [Accepted: 04/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time. PROCEDURE In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era. RESULTS Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time. CONCLUSIONS Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.
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Affiliation(s)
- Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Department of Pediatrics, Boston Medical Center, Boston MA
| | - Anran Li
- University of Michigan Medical School, Ann Arbor, MI
| | - Clement Ma
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Karina B. Ribeiro
- Department of Social Medicine, Faculdade de Ciencias Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Lisa Diller
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kira Bona
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Jonathan M. Marron
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Center for Bioethics, Harvard Medical School, Boston, MA
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33
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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34
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Wolfson JA. Poverty and Survival in Childhood Cancer: A Framework to Move Toward Systemic Change. J Natl Cancer Inst 2021; 113:227-230. [PMID: 33227815 DOI: 10.1093/jnci/djaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Julie Anna Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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