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Flores-Lujano J, Allende-López A, Duarte-Rodríguez DA, Alarcón-Ruiz E, López-Carrillo L, Shamah-Levy T, Cebrián ME, Baños-Lara MDR, Casique-Aguirre D, Elizarrarás-Rivas J, López-Aquino JA, Garrido-Hernández MÁ, Olvera-Caraza D, Terán-Cerqueda V, Martínez-José KB, Aristil-Chery PM, Alvarez-Rodríguez E, Herrera-Olivares W, Ruíz-Arguelles GJ, Chavez-Aguilar LA, Márquez-Toledo A, Cano-Cuapio LS, Luna-Silva NC, Martínez-Martell MA, Ramirez-Ramirez AB, Merino-Pasaye LE, Galván-Díaz CA, Medina-Sanson A, Gutiérrez-Rivera MDL, Martín-Trejo JA, Rodriguez-Cedeño E, Bekker-Méndez VC, Romero-Tlalolini MDLÁ, Cruz-Maza A, Juárez-Avendaño G, Pérez-Tapia SM, Rodríguez-Espinosa JC, Suárez-Aguirre MC, Herrera-Quezada F, Hernández-Díaz A, Galván-González LA, Mata-Rocha M, Olivares-Sosa AI, Rosas-Vargas H, Jiménez-Morales S, Cárdenas-González M, Álvarez-Buylla Roces ME, Duque-Molina C, Pelayo R, Mejía-Aranguré JM, Núñez-Enriquez JC. Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry. Front Oncol 2024; 14:1304263. [PMID: 38444682 PMCID: PMC10914251 DOI: 10.3389/fonc.2024.1304263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca). Methods A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype. Results A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states. Conclusion The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.
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Affiliation(s)
- Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aldo Allende-López
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- División de Desarrollo de la Investigación, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Erika Alarcón-Ruiz
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México, Instituto Tecnológico de Ciudad de Madero, Ciudad Madero, Tamaulipas, Mexico
| | - Lizbeth López-Carrillo
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Mariano E. Cebrián
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados (CINVESTAV), Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ma. del Rocío Baños-Lara
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
- Centro de Investigación Oncológica Una Nueva Esperanza, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Diana Casique-Aguirre
- Laboratorio de Citómica del Cáncer Infantil, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Delegación Puebla, Puebla, Mexico
- Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Mexico City, Mexico
| | - Jesús Elizarrarás-Rivas
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Oaxaca, Mexico
| | - Javier Antonio López-Aquino
- Coordinación Clínica de Educación e Investigación en Salud de la UMF No. 1, Instituto Mexicano del Seguro Social, Oaxaca, Mexico
| | | | - Daniela Olvera-Caraza
- Servicio de Oncohematología Pediátrica, Hospital para el Niño Poblano, Secretaria de Salud (SS), Puebla, Mexico
| | - Vanessa Terán-Cerqueda
- Servicio de Oncohematología Pediátrica, Instituto Mexicano del Seguro (IMSS) Unidad Médica de Alta Especialidad (UMAE) Centro Médico Nacional (CMN) Hospital de Especialidades Dr. Manuel Ávila Camacho, Puebla, Mexico
| | - Karina Beatriz Martínez-José
- Servicio de Hematología, Instituto Mexicano del Seguro (IMSS) Unidad Médica de Alta Especialidad (UMAE) Centro Médico Nacional (CMN) Hospital de Especialidades Dr. Manuel Ávila Camacho, Puebla, Mexico
| | - Pierre Mitchel Aristil-Chery
- Departamento de Enseñanza e Investigación, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla (ISSSTEP), Puebla, Mexico
| | - Enoch Alvarez-Rodríguez
- Servicio de Oncohematología Pediátrica, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla (ISSSTEP), Puebla, Mexico
- Servicio de Hematología Pediátrica, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Puebla, Mexico
| | - Wilfrido Herrera-Olivares
- Servicio de Oncohematología, Hospital General del Sur Dr. Eduardo Vázquez Navarro, Secretaria de Salud (SS), Puebla, Mexico
| | | | - Lénica Anahí Chavez-Aguilar
- Servicio de Hematología Pediátrica, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Puebla, Mexico
| | | | - Lena Sarahi Cano-Cuapio
- Servicio de Oncología Pediátrica, Hospital Infantil de Tlaxcala, Secretaria de Salud (SS), Tlaxcala, Mexico
| | - Nuria Citlalli Luna-Silva
- Servicio de Hemato-Oncología Pediátrica, Hospital de la Niñez Oaxaqueña “Dr. Guillermo Zárate Mijangos”, Secretaria de Salud y Servicios de Salud Oaxaca (SSO), Oaxaca, Mexico
| | - Maria Angélica Martínez-Martell
- Servicio de Hemato-Oncología Pediátrica, Hospital de la Niñez Oaxaqueña “Dr. Guillermo Zárate Mijangos”, Secretaria de Salud y Servicios de Salud Oaxaca (SSO), Oaxaca, Mexico
| | - Anabel Beatriz Ramirez-Ramirez
- Servicio de Oncocrean, Hospital General de Zona 01 “Dr. Demetrio Mayoral Pardo” Instituto Mexicano del Seguro Social (IMSS), Oaxaca, Mexico
| | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - César Alejandro Galván-Díaz
- Departamento de Oncología Pediátrica, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, Mexico
| | - Aurora Medina-Sanson
- Departamento de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Maria de Lourdes Gutiérrez-Rivera
- Servicio de Oncología, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Emmanuel Rodriguez-Cedeño
- Servicio de Hematología, Unidad Médica de Alta Especialidad, Hospital General “Dr. Gaudencio González Garza”, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Biomédica en Inmunología e Infectología, Hospital de Infectología “Dr. Daniel Méndez Hernández”, “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Astin Cruz-Maza
- Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
- Laboratorios Juárez Oaxaca, Oaxaca, Mexico
| | | | - Sonia Mayra Pérez-Tapia
- Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan Carlos Rodríguez-Espinosa
- Centro de Investigación Oncológica Una Nueva Esperanza, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Miriam Carmina Suárez-Aguirre
- Centro de Investigación Oncológica Una Nueva Esperanza, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
- Facultad de Biotecnología, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Fernando Herrera-Quezada
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Anahí Hernández-Díaz
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Lizbeth Alondra Galván-González
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Minerva Mata-Rocha
- Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Amanda Idaric Olivares-Sosa
- Dirección de Educación e Investigación, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Innovación y Medicina de Precisión, Núcleo A. Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | | | - Célida Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Rosana Pelayo
- Unidad de Oncoinmunología y Citómica, Centro de Investigación Biomédica de Oriente (CIBIOR), Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico
- Unidad de Educación e Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México City, Mexico
| | - Juan Carlos Núñez-Enriquez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
- Dirección de Educación e Investigación, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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Gramatges MM. Understanding and addressing race disparities in childhood cancer outcomes. Nat Rev Cancer 2024; 24:91-92. [PMID: 37985731 DOI: 10.1038/s41568-023-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- M Monica Gramatges
- Texas Children's Cancer and Hematology Center, Baylor College of Medicine, Houston, TX, USA.
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van Zwieten A, Dai J, Blyth FM, Wong G, Khalatbari-Soltani S. Overadjustment bias in systematic reviews and meta-analyses of socio-economic inequalities in health: a meta-research scoping review. Int J Epidemiol 2024; 53:dyad177. [PMID: 38129958 PMCID: PMC10859162 DOI: 10.1093/ije/dyad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias. METHODS We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear). RESULTS Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment. CONCLUSIONS Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jiahui Dai
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Pool A, Kuna EM, Anderson-Mellies A, Kreis A, Marable M, Fraley C, Pacheco D, Green AL. Medical Record Level-Evaluation of Impact of Demographic and Socioeconomic Factors on Pediatric Neuro-Oncology Outcomes at Children's Hospital Colorado. Res Sq 2024:rs.3.rs-3849043. [PMID: 38260550 PMCID: PMC10802725 DOI: 10.21203/rs.3.rs-3849043/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Purpose A medical record-level cohort study to investigate demographic and socioeconomic factors influencing treatment, timing of care, and survival outcomes in pediatric patients diagnosed with central nervous system (CNS) tumors. Methods Using electronic health records of patients at Children's Hospital Colorado from 1986-2020, we identified 898 patients treated for CNS tumors. The primary outcomes of interest were 5-year survival, timing of diagnosis, and treatment. Multivariable logistic regression and Cox regression were used to identify covariates associated with our outcomes of interest. Results We found that age, race, tumor type, diagnosis year, and social concerns influenced receipt and timing of treatment. Age, race, patient rural vs. urban residence, and tumor impacted survival outcomes. Time to presentation and treatment were significantly different between White and minority patients. American Indian/Alaska Native and Black patients were less likely to receive chemo compared to White patients (OR 0.28, 0.93 p = 0.037, < 0.001). Patients with 3 + social concerns were more likely to survive after 5 years than children with no or unknown social concerns (OR 1.84, p = 0.011). However, with an adjusted hazards ratio, children with 2 social concerns were less likely to survive to 5 years than children with no or unknown concerns (OR 0.58, p = 0.066). Conclusions Demographic and socioeconomic factors influence timing of care and survival outcomes in pediatric patients with CNS tumors. Minority status, age, social factors, rural, and urban patients experience differences in care. This emphasizes the importance of considering these factors and addressing disparities to achieve equitable care.
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Johnston H, Youshanlouei HR, Osei C, Patel AA, DuVall A, Wang P, Wanjari P, Segal J, Venkataraman G, Cheng JX, Gurbuxani S, Lager A, Fitzpatrick C, Thirman M, Nawas M, Liu H, Drazer M, Odenike O, Larson R, Stock W, Saygin C. Socioeconomic determinants of the biology and outcomes of acute lymphoblastic leukemia in adults. Blood Adv 2024; 8:164-171. [PMID: 38039510 PMCID: PMC10787242 DOI: 10.1182/bloodadvances.2023011862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Various socioeconomic and biologic factors affect cancer health disparities and differences in health outcomes. To better characterize the socioeconomic vs biologic determinants of acute lymphoblastic leukemia (ALL) outcomes, we conducted a single-institution, retrospective analysis of adult patients with ALL treated at the University of Chicago (UChicago) from 2010 to 2022 and compared our outcomes with the US national data (the Surveillance, Epidemiology, and End Results [SEER] database). Among 221 adult patients with ALL treated at UChicago, BCR::ABL1 was more frequent in patients with higher body mass index (BMI; odds ratio [OR], 7.64; 95% confidence interval [CI], 1.17-49.9) and non-Hispanic Black (NHB) ancestry (59% vs 24% in non-Hispanic White (NHW) and 20% in Hispanic patients; P = .001). In a multivariable analysis, age (hazard ratio [HR], 6.93; 95% CI, 2.27-21.1) and higher BMI at diagnosis (HR, 10.3; 95% CI, 2.56-41.5) were independent predictors of poor overall survival (OS). In contrast, race or income were not predictors of OS in the UChicago cohort. Analysis of the national SEER database (2010-2020) demonstrated worse survival outcomes in Hispanic and NHB patients than in NHW patients among adolescent and young adults (AYAs) but not in older adults (aged >40 years). Both AYA and older adult patients with higher median household income had better OS than those with lower income. Therefore, multidisciplinary medical care coupled with essential supportive care services offered at centers experienced in ALL care may alleviate the socioeconomic disparities in ALL outcomes in the United States.
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Affiliation(s)
| | | | - Clinton Osei
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Anand A. Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Adam DuVall
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Jeremy Segal
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Jason X. Cheng
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Angela Lager
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Michael Thirman
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Mariam Nawas
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Michael Drazer
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Larson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Caner Saygin
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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Leary SES, Onar-Thomas A, Fangusaro J, Gottardo NG, Cohen K, Smith A, Huang A, Haas-Kogan D, Fouladi M. Children's Oncology Group's 2023 blueprint for research: Central nervous system tumors. Pediatr Blood Cancer 2023; 70 Suppl 6:e30600. [PMID: 37534382 PMCID: PMC10569820 DOI: 10.1002/pbc.30600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
Tumors of the central nervous system (CNS) are a leading cause of morbidity and mortality in the pediatric population. Molecular characterization in the last decade has redefined CNS tumor diagnoses and risk stratification; confirmed the unique biology of pediatric tumors as distinct entities from tumors that occur in adulthood; and led to the first novel targeted therapies receiving Food and Drug Administration (FDA) approval for children with CNS tumors. There remain significant challenges to overcome: children with unresectable low-grade glioma may require multiple prolonged courses of therapy affecting quality of life; children with high-grade glioma have a dismal long-term prognosis; children with medulloblastoma may suffer significant short- and long-term morbidity from multimodal cytotoxic therapy, and approaches to improve survival in ependymoma remain elusive. The Children's Oncology Group (COG) is uniquely positioned to conduct the next generation of practice-changing clinical trials through rapid prospective molecular characterization and therapy evaluation in well-defined clinical and molecular groups.
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Affiliation(s)
- Sarah E. S. Leary
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s, Seattle, WA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | - Kenneth Cohen
- The Sidney Kimmel Comprehensive Cancer Center, John’s Hopkins, Baltimore, MD
| | - Amy Smith
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Orlando Health-Arnold Palmer Hospital, Orlando, FL
| | - Annie Huang
- Department of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Maryam Fouladi
- Division of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus OH
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Gramatges MM. Poverty and health equity in childhood leukemia. Blood 2023; 142:211-212. [PMID: 37471111 PMCID: PMC10375267 DOI: 10.1182/blood.2023020565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
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Castellanos MI, Oluyomi AO, Chambers TM, Gramatges MM, Winestone LE, Lupo PJ, Scheurer ME. Ethnic disparities in childhood leukemia survival by border residence: A Texas population-based analysis. Cancer 2023; 129:1276-1286. [PMID: 36805949 DOI: 10.1002/cncr.34636] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The US-Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas-Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. METHODS The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan-Meier methods. RESULTS During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5-year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. CONCLUSIONS Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs.
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Affiliation(s)
- Maria I Castellanos
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abiodun O Oluyomi
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany M Chambers
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lena E Winestone
- Division of Allergy, Immunology, and Blood and Marrow Transplant, University of California-San Francisco Benioff Children's Hospitals, San Francisco, California, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Berkman AM, Andersen CR, Hildebrandt MAT, Livingston JA, Green AL, Puthenpura V, Peterson SK, Milam J, Miller KA, Freyer DR, Roth ME. Risk of early death in adolescents and young adults with cancer: a population-based study. J Natl Cancer Inst 2023; 115:447-455. [PMID: 36682385 PMCID: PMC10086632 DOI: 10.1093/jnci/djac206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Advancements in treatment and supportive care have led to improved survival for adolescents and young adults (AYAs) with cancer; however, a subset of those diagnosed remain at risk for early death (within 2 months of diagnosis). Factors that place AYAs at increased risk of early death have not been well studied. METHODS The Surveillance, Epidemiology, and End Results registry was used to assess risk of early death in AYAs with hematologic malignancies, central nervous system tumors, and solid tumors. Associations between age at diagnosis, sex, race, ethnicity, socioeconomic status, insurance status, rurality, and early death were assessed. RESULTS A total of 268 501 AYAs diagnosed between 2000 and 2016 were included. Early death percentage was highest in patients diagnosed with hematologic malignancies (3.1%, 95% confidence interval [CI] = 2.9% to 3.2%), followed by central nervous system tumors (2.5%, 95% CI = 2.3% to 2.8%), and solid tumors (1.0%, 95% CI = 0.9% to 1.0%). Age at diagnosis, race, ethnicity, lower socioeconomic status, and insurance status were associated with increased risk of early death in each of the cancer types. For AYAs with hematologic malignancies and solid tumors, risk of early death decreased statistically significantly over time. CONCLUSIONS A subset of AYAs with cancer remains at risk for early death. In addition to cancer type, sociodemographic factors also affect risk of early death. A better understanding of the interplay of factors related to cancer type, treatment, and health systems that place certain AYA subsets at higher risk for early death is needed to address these disparities and improve outcomes.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam L Green
- Section of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Susan K Peterson
- Division of Cancer Prevention and Control, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joel Milam
- Departments of Medicine and Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Kimberly A Miller
- Departments of Population and Public Health Sciences and Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- Departments of Clinical Pediatrics, Medicine, and Population and Public Health Sciences, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Elshanbary AA, Zilai AH, Ishqair A, Matar SG, Nourelden AZ, Hafez AH, Altyar AE, Albadrani GM, Zaazouee MS. Demographic and treatment risk factors of cancer-specific mortality among children and adolescent leukemia patients: a population-based study. Environ Sci Pollut Res Int 2023; 30:19182-19193. [PMID: 36220963 DOI: 10.1007/s11356-022-23425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Leukemia is the 15th most commonly diagnosed cancer and the 11th leading cause of cancer mortality. The high mortality rate of leukemia could be attributed to numerous factors. Therefore, we aimed to identify the demographic and treatment risk factors influencing mortality among patients diagnosed with leukemia. Patients' data from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We used the Person's chi-square test to examine the associations among the categorical variables. Kaplan-Meier and Cox regression were applied for univariate and multivariate analyses. Standardized mortality ratios were utilized to compare the mortality rates of leukemia patients and the general US population. We carried out the statistical analysis using SPSS software. A total of 18,880 patients with leukemia were studied. The leukemia incidence was increased in children than in adolescents. Acute lymphoid leukemia (ALL) was the most common type diagnosed among children and adolescents: 10,331 and 4112 patients, respectively. All mortality ratios were significantly higher in leukemia patients compared to the US population. The risk of mortality among leukemia patients was higher among adolescents, females, Black, urban areas with a 20,000 population, and patients not receiving chemotherapy. In contrast, the mortality risk was decreased in patients with higher family incomes, those not treated with radiation, and diagnosed from 2000 to 2016. In conclusion, Leukemia's incidence increases with time. Adolescents, males, Black, in some urban areas, and patients who have not received chemotherapy had the highest mortality risk among leukemia patients.
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Affiliation(s)
| | - Ayat Hassan Zilai
- Department of Pediatrics, King Salman Hospital, Riyadh, Saudi Arabia
| | - Anas Ishqair
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | | | | | - Ahmed E Altyar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Ghadeer M Albadrani
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
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12
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Son M, Kim HR, Choe SA, Ki M, Yong F, Park M, Paek D. Widening Social Inequalities in Cancer Mortality of Children Under 5 Years in Korea. J Korean Med Sci 2023; 38:e20. [PMID: 36625176 PMCID: PMC9829512 DOI: 10.3346/jkms.2023.38.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To investigate the effect of parental social class on cancer mortality in children under 5 in Korea, two birth cohorts were constructed by linking national birth data to under-5 death data from the Statistics Korea for 1995-1999 (3,323,613 births) and 2010-2014 (2,297,876 births). METHODS The Cox proportional hazards model adjusted for covariates was used in this study. RESULTS Social inequalities of under-5 cancer mortality risk in paternal education and paternal employment status were greater in 2010-2014 than in 1995-1999. The gap of hazard ratio (HR) of under-5 cancer mortality between lower (high school or below) and higher (university or higher) paternal education increased from 1.23 (95% confidence interval, 1.041.46) in 1995-1999 to 1.45 (1.11-1.97) in 2010-2014; the gap of HR between parents engaged in manual work and non-manual work increased from 1.32 (1.12-1.56) in 1995-1999 to 1.45 (1.12-1.89) in 2010-2014 for fathers, and from 1.18 (0.7-1.98) to 1.69 (1.03-2.79) for mothers. When the parental social class was lower, the risk of under-5 cancer mortality was higher in not only adverse but normal births. CONCLUSION Social inequalities must be addressed to reduce the disparity in cancer mortality of children under 5 years old.
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Affiliation(s)
- Mia Son
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Hye Ri Kim
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- Division of Life Science, Korea University, Seoul, Korea
| | - Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Fran Yong
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Mijin Park
- Wonjin Institute for Occupational & Environmental Health, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Domyung Paek
- Wonjin Institute for Occupational & Environmental Health, Seoul, Korea
- National Cancer Center, Goyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea.
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13
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Janitz AE, Barber R, Campbell JE, Xu C, Pokala HR, Blanchard J, McNall-Knapp RY. Measuring disparities in event-free survival among children with acute lymphoblastic leukemia in an academic institute in Oklahoma, 2005-2019. Cancer Epidemiol 2022; 81:102275. [PMID: 36215916 PMCID: PMC10079780 DOI: 10.1016/j.canep.2022.102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. While there have been successes in the treatment of leukemia, less information is available on reasons for disparities in event-free survival (EFS) among underserved populations. METHODS We partnered with a children's hospital at an academic institution to abstract data from the institution's cancer registry, the state cancer registry, and electronic medical records on cancer diagnosis, treatment, and outcomes for children with ALL (n = 275) diagnosed from 2005 to 2019 prior to age 20. We evaluated the relation between 1) race/ethnicity, 2) distance to the children's hospital, and 3) area deprivation with EFS, defined as time from diagnosis to relapse, death, or the end of the study period. We evaluated differences in EFS using Kaplan-Meier analysis with the log-rank test. We used the Cox Proportional Hazards Model for multivariable survival analyses. RESULTS Most children were diagnosed with ALL under five years of age (45%) and with Pre-B ALL (87%). Twelve percent of children experienced a relapse and 5% died during induction or remission. EFS at 5 years was 82%. Non-Hispanic (NH) Black children had worse, though imprecise, EFS compared to NH White children (Adjusted Hazard Ratio: 2.07, 95% CI: 0.80, 5.38). Children residing in areas with higher deprivation had a higher adjusted hazard of poor outcomes compared to the least deprived areas, though estimates were imprecise (2nd quartile HR: 1.51, 3rd quartile: 1.85, 4th quartile: 1.62). We observed no association between distance to the children's hospital and EFS. CONCLUSION We observed poorer EFS for NH Black children and children residing in areas with high deprivation, though the estimates were not statistically significant. Our next steps include further evaluating socioeconomic factors in both rural and urban children to identify disparities in outcomes for children with ALL and other childhood cancers.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Rylee Barber
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Hanumantha R Pokala
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Jessica Blanchard
- Center for Applied Social Research, College of Arts and Sciences, University of Oklahoma, Norman, OK, 73072, United States.
| | - René Y McNall-Knapp
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
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14
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Muffly L, Yin J, Jacobson S, Wall A, Quiroz E, Advani AS, Luger SM, Tallman MS, Litzow MR, Foster MC, Erba HP, Appelbaum FR, Larson RA, Keegan THM, Stock W. Disparities in trial enrollment and outcomes of Hispanic adolescent and young adult acute lymphoblastic leukemia. Blood Adv 2022; 6:4085-92. [PMID: 35838753 DOI: 10.1182/bloodadvances.2022007197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Contrary to population data, survival of Hispanic AYA ALL patients enrolled on CALGB 10403 was equivalent to non-Hispanic patients. Geographical alignment between Hispanic patient incidence and trial sites may increase Hispanic patient enrollment onto clinical trials.
In this secondary analysis of Hispanic adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated on Cancer and Leukemia Group B (CALGB) 10403, we evaluated outcomes and geographic enrollment patterns relative to US population data. We used demographic, clinical, and survival data on AYAs enrolled on CALGB 10403 (N = 295, 2007-2012). Surveillance, Epidemiology, and End Results registries provided overall survival (OS) for US AYA ALL by ethnicity/race. North American Association of Cancer Registries provided AYA ALL incidence overall and proportion among Hispanics by US state. Of AYAs enrolled on CALGB 10403, 263 (89%) reported ethnicity/race: 45 (17%) Hispanic, 172 (65%) non-Hispanic White (NHW), 25 (10%) non-Hispanic Black (NHB), and 21 (8%) other. Compared with NHWs, Hispanic and NHB patients had lower household income, and Hispanic patients were more likely to harbor high-risk CRLF2 aberrations. Relative to US estimates, where Hispanic patients represented 46% of newly diagnosed AYA ALL patients and experienced inferior OS compared with NHW (P < .001), Hispanic AYAs on CALGB 10403 did as well as NHW patients (3 year OS, 75% vs 74%; P = NS). Hispanic patients also had higher rates of protocol completion (P = .05). Enrollments on CALGB 10403 differed relative to the distribution of Hispanic AYA ALL in the United States: enrollment was highest in the Midwest; t and only 15% of enrollees were from states with a high proportion of Hispanic AYA ALL patients. In summary, Hispanic patients treated on CALGB 10403 did as well as NHWs and better than population estimates. Geographical misalignment between trial sites and disease epidemiology may partially explain the lower-than-expected enrollment of Hispanic AYA ALL patients.
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Beckmann K, Kearney BJ, Yeung D, Hiwase D, Li M, Roder DM. Changes in five‐year survival for people with acute leukaemia in South Australia, 1980–2016. Med J Aust 2022; 216:296-302. [DOI: 10.5694/mja2.51423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Ming Li
- The University of South Australia Adelaide SA
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16
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Castellanos MI, Dongarwar D, Wanser R, Caceres I, Park C, Rodriguez J, Salihu HM. In-hospital Mortality and Racial Disparity in Children and Adolescents With Acute Myeloid Leukemia: A Population-based Study. J Pediatr Hematol Oncol 2022; 44:e114-e122. [PMID: 34001781 DOI: 10.1097/mph.0000000000002204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
Survival disparities in children and adolescents with acute myeloid leukemia (AML) are documented, however, the etiology of these disparities is understudied. Few studies have evaluated factors that predict in-hospital mortality in childhood AML and racial/ethnic disparities associated with in-hospital death. Our study aimed to investigate factors associated with the risk of in-hospital death among childhood AML hospitalizations. We conducted a retrospective study of childhood AML hospitalizations using the National Inpatient Sample (NIS) from 2003 to 2017. We estimated incidences of in-hospital death among AML hospitalizations. We performed survey logistic regression models to measure the association between patient and hospital characteristics and in-hospital mortality. We identified 71,050 hospitalizations of children with AML. Compared with non-Hispanic (NH) whites, NH-black children had a higher risk of in-hospital mortality (adjusted odds ratio: 1.41, 95% confidence interval: 1.06-1.87, P<0.02). Further, NH-black patients with hematopoietic stem cell transplant experienced the highest risk of mortality (adjusted odds ratio: 5.88, 95% confidence interval: 3.13-11.06, P<0.001) as compared with NH-black children who did not receive hematopoietic stem cell transplant. Our findings highlight that NH-black children with AML continue to experience a disproportionately higher likelihood of in-hospital mortality when compared with their NH-white counterparts. Further studies are needed to delineate the etiology of these disparities.
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Affiliation(s)
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research
| | - Rachelle Wanser
- Center of Excellence in Health Equity, Training, and Research
| | - Ibeth Caceres
- Center of Excellence in Health Equity, Training, and Research
| | - Charles Park
- Center of Excellence in Health Equity, Training, and Research
| | | | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
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Beltrami A, Hilliard A, Green AL. Demographic and socioeconomic disparities in pediatric cancer in the United States: Current knowledge, deepening understanding, and expanding intervention. Cancer Epidemiol 2021; 76:102082. [PMID: 34923289 DOI: 10.1016/j.canep.2021.102082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
While survival of pediatric cancer has improved greatly over the past 40 years, demographic and socioeconomic disparities have meant that some groups have not benefitted as much from these advances. We conducted a rapid review to summarize literature on demographic and socioeconomic disparities in outcomes of childhood cancer, starting in 2000. We find that unequal outcomes have been noted for many of these groups across hematologic malignancies, central nervous system tumors, and other solid tumors, although occasional studies have noted absence of disparities for particular at-risk groups and diseases, and gaps in understanding of disparities for some cancer subtypes and groups still exist. These include disparities in duration of overall survival, risk of death, more extensive disease at presentation, and differences/delays in treatment. Black race, Hispanic ethnicity, lack of private insurance, and adolescent/young adult age are most often associated with these poorer outcomes. We then delve into documented and theorized causes of these disparities, including impaired access to care and clinical trials, differences in cancer biology, treatment non-adherence, language barriers, and implicit racial bias. Here, it is clear that socioeconomic factors account for a large proportion of disparities seen, although not all, and that the causes of disparities are complex and interconnected and still need to be better understood. Finally, in an effort to shift emphasis to addressing disparities, we review interventions against disparities that have been studied in childhood cancer patients and other populations, including improving clinical trial representation, communication, health literacy, and family navigation. We suggest ways forward in disparity mitigation toward a goal of achieving equitable cancer outcomes for all children.
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Affiliation(s)
- Alina Beltrami
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Alexandra Hilliard
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Adam L Green
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO, United States.
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18
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Lee BM, Jecker NS, Marron JM, Rosenberg AR. Striving for equity: Patient prioritization during a critical cancer drug shortage. Pediatr Blood Cancer 2021; 68:e29280. [PMID: 34357696 DOI: 10.1002/pbc.29280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Brittany M Lee
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Nancy S Jecker
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA.,Fulbright U.S. Scholar Program, University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Jonathan M Marron
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Valcarcel B, Murillo F, Torres-Roman JS. Association of healthcare system factors with childhood leukemia mortality in Peru, 2017–2019: A population-based analysis. J Cancer Policy 2021; 29:100288. [DOI: 10.1016/j.jcpo.2021.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
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21
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Vercasson C, Auquier P, Michel G, Bertrand Y, Ansoborlo S, Tabone MD, Leverger G, Gandemer V, Baruchel A, Contet A, Dalle JH, Paillard C, Poirée M, Thouvenin-Doulet S, Sirvent N, Kanold J, Freycon C, Hamidou Z, Berbis J. Quality of life in parents of childhood leukemia survivors. A French Childhood Cancer Survivor Study for Leukemia study. Pediatr Blood Cancer 2020; 67:e28419. [PMID: 32798263 DOI: 10.1002/pbc.28419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Our objectives were to assess the quality of life (QoL) of parents of childhood leukemia survivors compared with population norms and to identify the determinants of parents' long-term QoL. METHODS Parents of minors who had survived childhood leukemia participating in the French LEA cohort (Leucémie de l'Enfant et de l'Adolescent-French Childhood Cancer Survivor Study for Leukemia) were asked to complete the French version of the WHOQOL-BREF. Results were compared with age- and sex-matched values from a French reference population. Parents' and survivors' characteristics likely to be associated with QoL, long after the child's leukemia diagnosis, were explored using multivariate analysis. RESULTS We included 487 parents (mean age 42.9 ± 6.0 years, mean follow-up time from diagnosis 7.3 ± 3.3 years). Compared with the reference population, scores for physical health and social relationships for parents of childhood leukemia survivors were significantly lower (P < 0.001, effect size = 0.24 and P < 0.001, effect size = 0.29, respectively) contrary to scores for psychological health which were significantly higher (P < 0.001, effect size = 0.29). Even if health- and cancer-related characteristics were associated with parents' QoL in some dimensions, the only factor associated with each of the three dimensions (social relationships, physical health, and psychological) in the multivariate analysis was the parent's financial situation. CONCLUSIONS Long after leukemia diagnosis, the parents reported lower scores in the physical health and social relationship domains. Despite the difficulties of actually influencing socioeconomic characteristics, it is important to consider the social situation of each family in the long-term care of survivors and their families.
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Affiliation(s)
- Camille Vercasson
- Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France
| | - Gérard Michel
- Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France.,Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille Univ, Marseille, France
| | - Yves Bertrand
- Department of Pediatric Hematology and Oncology, University Hospital of Lyon, Lyon, France
| | - Sophie Ansoborlo
- Department of Pediatric Hematology and Oncology, University Hospital of Bordeaux, Bordeaux, France
| | - Marie-Dominique Tabone
- Department of Pediatric Hematology and Oncology, A. Trousseau Hospital, AP-HP, Paris, France
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, A. Trousseau Hospital, AP-HP, Paris, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - André Baruchel
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - Audrey Contet
- Department of Pediatric Onco-Haematology, Children's Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Jean-Hugues Dalle
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - Catherine Paillard
- Department of Pediatric Hematology-Oncology, University Hospital, Strasbourg, France
| | - Maryline Poirée
- Department of Pediatric Hematology and Oncology, University Hospital L'Archet, Nice, France
| | | | - Nicolas Sirvent
- Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France
| | - Justyna Kanold
- Department of Pediatric Hematology and Oncology, CIC Inserm 501, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Claire Freycon
- Department of Pediatric Hematology-Oncology, University Hospital of Grenoble, Grenoble, France
| | - Zeinab Hamidou
- Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France.,National Clinical Research Quality of Life in Oncology Platform, Nancy, France
| | - Julie Berbis
- Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France
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Rotz SJ, Wei W, Thomas SM, Hanna R. Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia. Cancer 2020; 126:5319-5327. [PMID: 32910494 DOI: 10.1002/cncr.33175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Socioeconomic and demographic categories such as income, race, insurance status, and treatment center type are associated with outcomes in acute leukemia. This study was aimed at determining whether the distance to treatment center affects overall survival for children and young adults with acute leukemia. METHODS The National Cancer Database was queried for patients 39 years old or younger who were diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). A backward elimination procedure was used to select final multivariate Cox models. RESULTS In total, 12,301 patients with AML and 22,683 patients with ALL were analyzed. The ALL model included distance to treatment center, Charlson-Deyo score, age, race, insurance status, and community income level. US census definitions of urban and rural were not statistically significant, and no interaction was significant for included variables. Compared with distances > 50 miles, all other distances were associated with improved survival (hazard ratio [HR] for ≤10 miles, 0.91; P = .04; HR for >10 to ≤20 miles, 0.86; P = .004; HR for >20 to ≤50 miles, 0.87; P = .005). The final model for AML included the same variables as the ALL model except for distance to treatment center, which was not statistically significant. CONCLUSIONS For children and young adults with ALL, distances > 50 miles are associated with inferior overall survival; however, no difference is seen for AML. Although it is unknown whether differences in survival for patients with ALL based on distance are driven by relapse or treatment-related mortality, increased attention to adherence, supportive care, and logistics for patients traveling long distances is warranted. LAY SUMMARY For children and young adults with acute lymphoblastic leukemia, living more than 50 miles from the treatment center is associated with worse outcomes.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wei Wei
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rabi Hanna
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
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Alicandro G, Bertuccio P, Sebastiani G, La Vecchia C, Frova L. Parental education and cancer mortality in children, adolescents, and young adults: A case‐cohort study within the 2011 Italian census cohort. Cancer 2020; 126:4753-4760. [DOI: 10.1002/cncr.33146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Gianfranco Alicandro
- National Institute of Statistics, Directorate for Social Statistics and Welfare, Integrated System for Health, Social Assistance, and Welfare Rome Italy
| | - Paola Bertuccio
- L. Sacco Department of Biomedical and Clinical Sciences University of Milan Milan Italy
| | - Gabriella Sebastiani
- National Institute of Statistics, Directorate for Social Statistics and Welfare, Integrated System for Health, Social Assistance, and Welfare Rome Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Luisa Frova
- National Institute of Statistics, Directorate for Social Statistics and Welfare, Integrated System for Health, Social Assistance, and Welfare Rome Italy
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24
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Fineberg R, Zahedi S, Eguchi M, Hart M, Cockburn M, Green AL. Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States. Sci Rep 2020; 10:4588. [PMID: 32165703 DOI: 10.1038/s41598-020-61237-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/18/2020] [Indexed: 11/09/2022] Open
Abstract
Previous studies have demonstrated effects of racial and socioeconomic factors on survival of adults with cancer. While less studied in the pediatric population, data exist demonstrating disparities of care and survival in pediatric oncology patients based on socioeconomic and racial/ethnic factors. Brain cancers recently overtook leukemia as the number one cause of childhood cancer fatalities, but demographic and socioeconomic disparities in these tumors have not been adequately studied. We obtained data from the SEER Program of the National Cancer Institute (NCI). We selected patients under 19 years of age with central nervous system (CNS) cancers diagnosed between 2000 and 2015. We included patient demographics, tumor characteristics, treatment, and socioeconomic characteristics as covariates in the analysis. We measured overall survival and extent of disease at diagnosis. We saw that Black and Hispanic patients overall had a higher risk of death than non-Hispanic White patients on multivariable analysis. On stratified analysis, Black and Hispanic patients with both metastatic and localized disease at diagnosis had a higher risk of death compared to White, non-Hispanic patients, although the difference in Black patients was not significant after adjusting for mediating factors. However, our findings on extent of disease at diagnosis demonstrated that neither Black race nor Hispanic ethnicity increased the chance of metastatic disease at presentation when controlling for mediating variables. In summary, racial and ethnic disparities in childhood CNS tumor survival appear to have their roots at least partially in post-diagnosis factors, potentially due to the lack of access to high quality care, leading to poorer overall outcomes.
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Totadri S, Trehan A, Kaur A, Bansal D. Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia. Indian J Med Res 2019; 149:26-33. [PMID: 31115371 PMCID: PMC6507537 DOI: 10.4103/ijmr.ijmr_579_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients’ database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata (P=0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent (P=0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P=0.015); 1.98 (P=0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Appinderjit Kaur
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Cárceles-Álvarez A, Ortega-García JA, López-Hernández FA, Fuster-Soler JL, Ramis R, Kloosterman N, Castillo L, Sánchez-Solís M, Claudio L, Ferris-Tortajada J. Secondhand smoke: A new and modifiable prognostic factor in childhood acute lymphoblastic leukemias. Environ Res 2019; 178:108689. [PMID: 31479979 DOI: 10.1016/j.envres.2019.108689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The 5-year overall survival (OS) in childhood acute lymphoblastic leukemia (ALL) has reached 90% in high-income countries, levels that can no be longer overcome with strategies based on intensification of treatment. Other approaches in the search for new and modifiable prognostic factors are necessary to continue to improve these rates. The importance of environmental factors in the etiopathogenesis of childhood ALL has been regaining interest but its role in the prognosis and survival of this disease is not well explored. We aim to investigate the association between secondhand smoke (SHS) and survival in children diagnosed with ALL. METHODS We analyzed survival rates in 146 patients under the age of 15 years diagnosed with ALL between January 1998 and May 2016 in the Region of Murcia, Spain. Evaluation of parental SHS and other known prognostic factors (sex, age, white blood cell count at diagnosis, cytogenetics, NCI/Rome Criteria, early response to therapy, and relapse) were assessed for impact on OS, event-free survival (EFS), cumulative incidence of relapse (CIR), and treatment-related mortality (CITRM) using Kaplan-Meier analysis, Cox regression, and Fine-Gray model. RESULTS The mean follow-up time was 105.3 months (±66.5). Prenatal exposure to SHS due to parental smoking was highly prevalent. Of the mothers, 44.4% and 55.5% of the fathers smoked at some point during pregnancy. After the child's diagnosis of ALL 39.7% of mothers and 45.9% of fathers reported smoking. The Cox proportional hazards model showed that maternal smoking during pregnancy and after diagnosis (HR = 4.396, 95% CI: 1.173-16.474, p = 0.028); and relapse (HR = 7.919; 95% CI: 2.683-21.868; p < 0.001) are independent prognostic factors in determining survival. The Fine-Gray model showed that maternal smoking during pregnancy and after diagnosis (HR = 14.525, 95% CI: 4.228-49.90, p < 0.001) is an independent prognostic factor in CITRM. CONCLUSIONS Persistent SHS worsens OS and TRM in children with ALL. This negative impact contributes to a different prognosis and may possibly provide an exceptional insight into new therapeutic approaches, including environmental aspects such as prevention and smoking cessation to improve survival outcomes.
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Affiliation(s)
- Alberto Cárceles-Álvarez
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - Juan A Ortega-García
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain.
| | - Fernando A López-Hernández
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Department of Quantitative Methods and Computing, Technical University of Cartagena, Spain
| | - José L Fuster-Soler
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Onco-Hematology Section, Department of Pediatrics, Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Rebeca Ramis
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain; Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain
| | - Nicole Kloosterman
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - Luis Castillo
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Onco-Hematology Department, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Manuel Sánchez-Solís
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Neumology Section, Department of Pediatrics, Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Luz Claudio
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Department of Environmental Medicine and Public Health, Division of International Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josep Ferris-Tortajada
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Environmental Health Committee, Spanish Pediatric Association, Madrid, Spain
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Ramsey LH, Graves PE, Howard Sharp KM, Seals SR, Collier AB, Karlson CW. Impact of Race and Socioeconomic Status on Psychologic Outcomes in Childhood Cancer Patients and Caregivers. J Pediatr Hematol Oncol 2019; 41:433-7. [PMID: 30629003 DOI: 10.1097/MPH.0000000000001405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complex relationships between race and socioeconomic status have a poorly understood influence on psychologic outcomes in pediatric oncology. The Family Symptom Inventory was used to assess symptoms of depression and anxiety in pediatric patients with cancer and their caregivers. Separate hierarchical linear regression models examined the relationship between demographic variables, cancer characteristics, socioeconomic status, and access to care and patient or caregiver depression/anxiety. Participants included 196 pediatric patients with cancer (mean age, 11.21 y; 49% African American) and their caregivers. On average, caregivers reported low levels of depression/anxiety. Symptoms of depression and anxiety in patients were correlated with poorer mental health in caregivers (r=0.62; P<0.01). Self-reported financial difficulty (β=0.49; P<0.001) and brain cancer diagnosis for their child (β=0.42; P=0.008) were significantly associated with depression and anxiety in caregivers. Analysis did not reveal significant associations between race, household income, or access to care and patient or caregiver depression/anxiety. Perception of financial hardship can adversely impact mental health in caregivers of children with cancer. Psychosocial assessment and interventions may be especially important for caregivers of patients with brain tumors and caregivers who report feeling financial difficulty.
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Hentea C, Downs SM, Tucker Edmonds B, Vik T, Wiehe SE, Cheng ER. Impact of socioeconomic markers on parents' retention of pediatric oncology home care education: A pilot study. Pediatr Blood Cancer 2019; 66:e27624. [PMID: 30693652 DOI: 10.1002/pbc.27624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022]
Abstract
Little is known about the extent to which parents retain the education on how to manage home medical emergencies. We sought to describe retention of pediatric oncology home care education (POHCE) in a cohort of 24 parents of newly diagnosed children with cancer and investigate sociodemographic disparities in this retention. We measured retention using a vignette-based survey instrument. The mean score was 4 (range 0-6, SD = 1.6) and parents with high school only education and those with limited cancer health literacy scored lowest (2.5 and 2.8, respectively). Future POHCE interventions can focus on parents' literacy and education levels as predictors to tailor alternative education strategies.
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Affiliation(s)
- Cristiana Hentea
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Stephen M Downs
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
| | - Brownsyne Tucker Edmonds
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
| | - Terry Vik
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
| | - Erika R Cheng
- Children's Health Services Research, Indiana University, Indianapolis, Indiana
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Sergentanis TN, Ntanasis-Stathopoulos I, Tzanninis IG, Gavriatopoulou M, Sergentanis IN, Dimopoulos MA, Psaltopoulou T. Meat, fish, dairy products and risk of hematological malignancies in adults - a systematic review and meta-analysis of prospective studies. Leuk Lymphoma 2019; 60:1978-1990. [PMID: 30912696 DOI: 10.1080/10428194.2018.1563693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This systematic review and meta-analysis of cohort studies examine the association of meat, fish, and dairy product consumption with the risk of hematological neoplasms in adults. Thirteen studies encompassing 1,480,986 participants and 10,442 incident cases were included. Red or processed meat consumption was not associated with the risk of leukemia, acute myeloid leukemia, non-Hodgkin lymphoma (NHL) and small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL/SLL). Poultry consumption did not seem to affect the risk of leukemia, NHL, CLL/SLL, and multiple myeloma (MM). Fish consumption was not associated with leukemia, NHL, CLL/SLL, and MM risk. Interestingly though, fish consumption was positively associated with myeloid leukemia risk (pooled RR = 1.74, 95% CI: 1.22-2.47, random effects, highest vs. lowest category). Milk and dairy product consumption was not associated with NHL and leukemia risk. In conclusion, methodologically strict prospective studies are mandatory, in order to extract reliable conclusions concerning the role of these dietary factors in hematological malignancies.
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Affiliation(s)
- Theodoros N Sergentanis
- a Department of Hygiene, Epidemiology and Medical Statistics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Ioannis Ntanasis-Stathopoulos
- a Department of Hygiene, Epidemiology and Medical Statistics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece.,b Department of Clinical Therapeutics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Ioannis-Georgios Tzanninis
- a Department of Hygiene, Epidemiology and Medical Statistics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Maria Gavriatopoulou
- b Department of Clinical Therapeutics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Meletios A Dimopoulos
- b Department of Clinical Therapeutics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Theodora Psaltopoulou
- a Department of Hygiene, Epidemiology and Medical Statistics , School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
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Psaltopoulou T, Sergentanis TN, Ntanasis-Stathopoulos I, Tzanninis IG, Riza E, Dimopoulos MA. Anthropometric characteristics, physical activity and risk of hematological malignancies: A systematic review and meta-analysis of cohort studies. Int J Cancer 2019; 145:347-359. [PMID: 30614529 DOI: 10.1002/ijc.32109] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/02/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
Overweight/obesity, adult attained height and physical activity are possible risk factors for hematological malignancies. This meta-analysis aims to evaluate the associations between these factors and hematological cancer risk in adults. Eligible cohort studies were sought in PubMed up to May 31, 2016; overall, 44 studies were included in the present analyses. Pooled relative risk estimates were calculated using random-effects models; separate analyses were conducted for non-Hodgkin lymphoma (NHL) and subtypes (diffuse large B-cell lymphoma, DLBCL; follicular cell lymphoma; small lymphocytic lymphoma/chronic lymphocytic leukemia, SLL/CLL), Hodgkin lymphoma (HL), multiple myeloma (MM), leukemia and subtypes (acute lymphoblastic leukemia, acute myeloid leukemia, AML). Obesity was associated with increased risk of NHL, HL, MM, leukemia overall and AML in both sexes, as well as with higher DLBCL risk in women; the dose-response meta-regression analysis confirmed these associations. Less pronounced effects were observed regarding overweight, as it was associated with increased MM risk in both sexes, NHL risk in males, DLBCL and overall leukemia risk in females. Taller men presented with significantly higher risk of NHL and taller women were affected by higher risk of NHL, DLBCL, FL, CLL/SLL, MM, leukemia and AML. On the other hand, physical activity and abdominal fatness were not associated with the risk of hematological malignancies. In conclusion, this meta-analysis highlights the pivotal role of anthropometric measures in shaping the risk of hematological malignancies in adults. Additional, well-designed studies stemming from all the continents are needed for the further substantiation and generalization of the results.
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Affiliation(s)
- Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis-Georgios Tzanninis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Shao Y, Tan B, Shi J, Zhou Q. Methotrexate induces astrocyte apoptosis by disrupting folate metabolism in the mouse juvenile central nervous system. Toxicol Lett 2019; 301:146-156. [DOI: 10.1016/j.toxlet.2018.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 01/23/2023]
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Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.
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Affiliation(s)
- Rebecca L Siegel
- Scientific Director, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Senior Associate Scientist, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Bjur KA, Wi CI, Ryu E, Derauf C, Crow SS, King KS, Juhn YJ. Socioeconomic Status, Race/Ethnicity, and Health Disparities in Children and Adolescents in a Mixed Rural-Urban Community-Olmsted County, Minnesota. Mayo Clin Proc 2019; 94:44-53. [PMID: 30611453 PMCID: PMC6360526 DOI: 10.1016/j.mayocp.2018.06.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize disparities in childhood health outcomes by socioeconomic status (SES) and race/ethnicity in a mixed rural-urban US community. METHODS This was a retrospective population-based study of children 18 years and younger residing in Olmsted County, Minnesota, in 2009. The prevalence rates of childhood health outcomes were determined using International Classification of Diseases, Ninth Revision codes. Socioeconomic status was measured using the HOUsing-based SocioEconomic Status index (HOUSES), derived from real property data. Adjusting for age and sex, logistic regression models were used to examine the relationships among HOUSES, race/ethnicity, and prevalence of childhood health outcomes considering an interaction between HOUSES and race/ethnicity. Odds ratios were calculated using the lowest SES quartile and non-Hispanic white participants as the reference groups. RESULTS Of 31,523 eligible children, 51% were male and 86% were of non-Hispanic white race/ethnicity. Overall, lower SES was associated with higher prevalence of bronchiolitis, urinary tract infection, asthma, mood disorder, and accidents/adverse childhood experiences (physical and sexual abuse) in a dose-response manner (P<.04). Prevalence rates of all childhood conditions considered except for epilepsy were significantly different across races/ethnicities (P<.002). Racial/ethnic disparities for asthma and mood disorder were greater with higher SES. CONCLUSION Significant health disparities are present in a predominantly affluent, non-Hispanic white, mixed rural-urban community. Socioeconomic status modifies disparities by race/ethnicity in clinically less overt conditions. Interpretation of future health disparity research should account for the nature of disease.
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Affiliation(s)
- Kara A Bjur
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Chris Derauf
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Sheri S Crow
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Katherine S King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
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Mogensen H, Modig K, Tettamanti G, Erdmann F, Heyman M, Feychting M. Survival After Childhood Cancer-Social Inequalities in High-Income Countries. Front Oncol 2018; 8:485. [PMID: 30474007 PMCID: PMC6238081 DOI: 10.3389/fonc.2018.00485] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Despite substantial improvements in survival from childhood cancer during the last decades, there are indications that survival rates for several cancer types are no longer improving. Moreover, evidence accumulates suggesting that socioeconomic and sociodemographic factors may have an impact on survival also in high-income countries. The aim of this review is to summarize the findings from studies on social factors and survival in childhood cancer. Several types of cancer and social factors are included in order to shed light on potential mechanisms and identify particularly affected groups. A literature search conducted in PubMed identified 333 articles published from December 2012 until June 2018, of which 24 fulfilled the inclusion criteria. The findings are diverse; some studies found no associations but several indicated a social gradient with higher mortality among children from families of lower socioeconomic status (SES). There were no clear suggestions of particularly vulnerable subgroups, but hematological malignancies were most commonly investigated. A wide range of social factors have been examined and seem to be of different importance and varying between studies. However, potential underlying mechanisms linking a specific social factor to childhood cancer survival was seldom described. This review provides some support for a relationship between lower parental SES and worse survival after childhood cancer, which is a finding that needs further attention. Studies investigating predefined hypotheses involving specific social factors within homogenous cancer types are lacking and would increase the understanding of mechanisms involved, and allow targeted interventions to reduce health inequalities.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Psaltopoulou T, Ntanasis-Stathopoulos I, Tsilimigras DI, Tzanninis IG, Gavriatopoulou M, Sergentanis TN. Micronutrient Intake and Risk of Hematological Malignancies in Adults: A Systematic Review and Meta-analysis of Cohort Studies. Nutr Cancer 2018; 70:821-839. [PMID: 30288994 DOI: 10.1080/01635581.2018.1490444] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There has been accumulating evidence that several micronutrients may play a protective role in the risk of solid cancers. However, their role in hematological malignancies remains to be elucidated; this meta-analysis aims to evaluate the associations between micronutrient intake as well as supplementation and risk of hematological cancer in adults. Eligible cohort studies (examining intake of vitamin A, vitamin C, vitamin D, vitamin E, lycopene, folate, iron, carotenoids, beta-carotene, selenium, pyridoxine) were sought in PubMed up to July 31, 2016. Random-effects models were used for the calculation of pooled relative risks (RR) with their 95% confidence intervals (CI). Twelve cohort studies were deemed eligible. Null associations were noted regarding supplemented vitamin A (pooled relative risk [RR] = 0.92, 95% confidence interval [CI]: 0.80-1.07), supplemented vitamin C (pooled RR = 1.00, 95%CI: 0.90-1.12), total vitamin D (pooled RR = 1.05, 95%CI: 0.91-1.20), supplemented vitamin E (pooled RR = 0.98, 95%CI: 0.88-1.10), and dietary lycopene intake (pooled RR = 1.00, 95%CI: 0.86-1.16) and the risk of non-Hodgkin lymphoma. No summary estimates are provided for other hematological malignancies due to the limited number of studies. Future prospective trials should be conducted for a better understanding of this field; especially regarding Hodgkin lymphoma, leukemia and plasma cell neoplasms, on which data are scarce.
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Affiliation(s)
- Theodora Psaltopoulou
- a Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- b Department of Clinical Therapeutics , Alexandra Hospital , School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
| | - Diamantis I Tsilimigras
- a Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
| | - Ioannis-Georgios Tzanninis
- a Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
| | - Maria Gavriatopoulou
- b Department of Clinical Therapeutics , Alexandra Hospital , School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
| | - Theodoros N Sergentanis
- a Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine , National and Kapodistrian University of Athens , Athens, Greece
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Abstract
OBJECTIVES To describe pediatric palliative care (PPC) in pediatric oncology, the importance of PPC for pediatric oncology patients, disparities within pediatric palliative oncology, innovative strategies for improving PPC access in underserved populations, and implications for oncology nursing practice. DATA SOURCES Published pediatric oncology and palliative peer-reviewed articles and guidance documents. CONCLUSION Disparities exist within pediatric palliative oncology. There is much work needed to improve the reach and quality of PPC for pediatric oncology patients, especially those from underserved populations. IMPLICATIONS FOR NURSING PRACTICE Nurses serve a critical role in advocating for PPC for seriously ill pediatric cancer patients and their families.
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Zheng DJ, Krull KR, Chen Y, Diller L, Yasui Y, Leisenring W, Brouwers P, Howell R, Lai JS, Balsamo L, Oeffinger KC, Robison LL, Armstrong GT, Kadan-Lottick NS. Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study. Cancer 2018; 124:3220-3230. [PMID: 29888538 DOI: 10.1002/cncr.31379] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P = .003), headstrong behavior (19% vs 13%; P < .001), attention deficits (21% vs 13%; P < .001), peer conflict/social withdrawal (26% vs 17%; P < .001), and antisocial behavior (16% vs 12%; P = .01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P < .001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤ .004). Endocrine disease (P ≤ .004) and peripheral neuropathy (P ≤ .02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Daniel J Zheng
- Yale University School of Medicine, New Haven, Connecticut.,Boston Children's Hospital, Boston, Massachusetts.,Boston Medical Center, Boston, Massachusetts
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Diller
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Pim Brouwers
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Rebecca Howell
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin-Shei Lai
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lyn Balsamo
- Yale University School of Medicine, New Haven, Connecticut.,Yale Comprehensive Cancer Center, New Haven, Connecticut
| | | | | | | | - Nina S Kadan-Lottick
- Yale University School of Medicine, New Haven, Connecticut.,Yale Comprehensive Cancer Center, New Haven, Connecticut
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de Vries E, Buitrago G, Quitian H, Wiesner C, Castillo JS. Access to cancer care in Colombia, a middle-income country with universal health coverage. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Xie S, Hossain MJ. Survival differences in childhood and young adult acute myeloid leukemia: A cross-national study using US and England data. Cancer Epidemiol 2018; 54:19-24. [PMID: 29554538 DOI: 10.1016/j.canep.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a serious disease with complex etiology and marked variation in survival. Known prognostic factors include AML subtypes, age at diagnosis and sex. However, survival outcomes may vary across healthcare systems. In this study, we evaluated the survival patterns in individuals diagnosed with AML at ages 0-24 years in the US and England between prognostic features and across countries. METHODS We obtained data on 4387 and 2194 subjects from the US Surveillance Epidemiology and End Result registries and UK National Cancer Data Repository. Subjects were diagnosed and followed in 1995-2014. Kaplan-Meier curve and stratified Cox proportional hazards regression were used in the analysis. RESULTS Overall risk of mortality was 23% lower in English patients compared to that in the US patients (adjusted hazard ratio (aHR), 95% confidence Interval (CI): 0.77, 0.71-0.84). Survival difference of similar extent was observed in subgroups of sex and age at diagnosis. However, mortality risks between two countries varied substantially across AML subtypes, especially in AML inv(16) (1.81, 0.61-5.34), AML with minimal differentiation (0.54, 0.25-1.17), AML without maturation (0.38, 0.20-0.74) and AML with maturation (0.52, 0.31-0.86). CONCLUSIONS Similar to the population trend, mortality risk across sex, age at diagnosis, and most AML subtypes was lower in England. Survival outcome for AML with and without maturation in England was better than the population trend, while that for AML inv(16) was worse. Our findings suggest that future etiologic and policy research may uncover the underlying mechanisms and contribute to closing these morality gaps.
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Affiliation(s)
- Sherlly Xie
- Biostatistics Core, Nemours Biomedical Research, A I duPont Hospital for Children, Wilmington, DE 19803, United States
| | - Md Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, A I duPont Hospital for Children, Wilmington, DE 19803, United States; Department of Applied Economics and Statistics, University of Delaware, Newark, DE 19716, United States.
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Scheurer ME, Lupo PJ, Schüz J, Spector LG, Wiemels JL, Aplenc R, Gramatges MM, Schiffman JD, Pombo-de-Oliveira MS, Yang JJ, Heck JE, Metayer C, Orjuela-Grimm MA, Bona K, Aristizabal P, Austin MT, Rabin KR, Russell HV, Poplack DG. An overview of disparities in childhood cancer: Report on the Inaugural Symposium on Childhood Cancer Health Disparities, Houston, Texas, 2016. Pediatr Hematol Oncol 2018; 35:95-110. [PMID: 29737912 PMCID: PMC6685736 DOI: 10.1080/08880018.2018.1464088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Inaugural Symposium on Childhood Cancer Health Disparities was held in Houston, Texas, on November 2, 2016. The symposium was attended by 109 scientists and clinicians from diverse disciplinary backgrounds with interests in pediatric cancer disparities and focused on reviewing our current knowledge of disparities in cancer risk and outcomes for select childhood cancers. Following a full day of topical sessions, everyone participated in a brainstorming session to develop a working strategy for the continued expansion of research in this area. This meeting was designed to serve as a springboard for examination of childhood cancer disparities from a more unified and systematic approach and to enhance awareness of this area of need.
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Affiliation(s)
- Michael E Scheurer
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Philip J Lupo
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Joachim Schüz
- c Section of Environment and Radiation , International Agency for Research on Cancer , Lyon , France
| | - Logan G Spector
- d Division of Epidemiology and Clinical Research, Department of Pediatrics , University of Minnesota , Minneapolis , MN , USA
| | - Joseph L Wiemels
- e Department of Preventative Medicine , University of Southern California , Los Angeles , CA , USA
| | - Richard Aplenc
- f Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - M Monica Gramatges
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Joshua D Schiffman
- g Department of Pediatrics and Department of Oncological Sciences , Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Maria S Pombo-de-Oliveira
- h Programa de Hematologia-Oncologia Pediátrico , Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Jun J Yang
- i Department of Pharmaceutical Sciences , St Jude Children's Research Hospital , Memphis , TN , USA
| | - Julia E Heck
- j Department of Epidemiology , University of California Los Angeles , Los Angeles , CA , USA
| | - Catherine Metayer
- k Department of Epidemiology , University of California Berkeley , Berkeley , CA , USA
| | - Manuela A Orjuela-Grimm
- l Departments of Epidemiology and Pediatrics (Oncology) , Columbia University , New York , NY , USA
| | - Kira Bona
- m Department of Pediatrics , Harvard University , Boston , MA , USA
- n Department of Pediatric Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Paula Aristizabal
- o Department of Pediatrics , University of California San Diego , San Diego , CA , USA
- p Rady Children's Hospital , San Diego , CA , USA
| | - Mary T Austin
- q Department of Pediatric Surgery , The University of Texas Health Science Center at Houston , Houston , TX , USA
- r Departments of Surgical Oncology and Pediatrics Patient Care , MD Anderson Cancer Center , Houston , TX , USA
| | - Karen R Rabin
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Heidi V Russell
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - David G Poplack
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
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Gilbert K, Nangia AK, Dupree JM, Smith JF, Mehta A. Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology? Urol Oncol 2018; 36:92.e1-9. [DOI: 10.1016/j.urolonc.2017.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
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Abstract
Individuals diagnosed with hematologic malignancies experience significant unmet psychological, physical, informational, financial, and spiritual needs. The goal of the current review is to summarize and highlight recent research focused on these issues in the diagnosis and treatment periods and beyond. The review also describes the needs of adolescent and young adult (AYA) and pediatric patients. While a large body of research has reported on unmet needs among adult hematologic cancer patients, there is far less data regarding the challenges confronted by AYA and pediatric populations. Available data suggests that among all age groups, hematopoietic cell transplantation (HCT) is a risk factor for greater unmet needs. Recommendations for screening and evidence-based interventions to prevent or ameliorate unmet needs are provided. Future research is needed to develop additional evidence-based psychosocial interventions with a focus on hematologic cancer.
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Affiliation(s)
- Anna Barata
- Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- IIB Sant Pau and Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | | | | | - Heather S L Jim
- Moffitt Cancer Center, 12902 Magnolia Drive MRC-PSY, Tampa, FL, 33612, USA.
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Sergentanis TN, Psaltopoulou T, Ntanasis-Stathopoulos I, Liaskas A, Tzanninis IG, Dimopoulos MA. Consumption of fruits, vegetables, and risk of hematological malignancies: a systematic review and meta-analysis of prospective studies. Leuk Lymphoma 2017; 59:434-447. [DOI: 10.1080/10428194.2017.1339873] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Theodoros N. Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Liaskas
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis-Georgios Tzanninis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Gkourogianni A, Sinaii N, Jackson SH, Karageorgiadis AS, Lyssikatos C, Belyavskaya E, Keil MF, Zilbermint M, Chittiboina P, Stratakis CA, Lodish MB. Pediatric Cushing disease: disparities in disease severity and outcomes in the Hispanic and African-American populations. Pediatr Res 2017; 82:272-7. [PMID: 28422946 DOI: 10.1038/pr.2017.58] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/12/2017] [Indexed: 02/08/2023]
Abstract
BackgroundLittle is known about the contribution of racial and socioeconomic disparities to severity and outcomes in children with Cushing disease (CD).MethodsA total of 129 children with CD, 45 Hispanic/Latino or African-American (HI/AA) and 84 non-Hispanic White (non-HW), were included in this study. A 10-point index for rating severity (CD severity) incorporated the degree of hypercortisolemia, glucose tolerance, hypertension, anthropomorphic measurements, disease duration, and tumor characteristics. Race, ethnicity, age, gender, local obesity prevalence, estimated median income, and access to care were assessed in regression analyses of CD severity.ResultsThe mean CD severity in the HI/AA group was worse than that in the non-HW group (4.9±2.0 vs. 4.1±1.9, P=0.023); driving factors included higher cortisol levels and larger tumor size. Multiple regression models confirmed that race (P=0.027) and older age (P=0.014) were the most important predictors of worse CD severity. When followed up a median of 2.3 years after surgery, the relative risk for persistent CD combined with recurrence was 2.8 times higher in the HI/AA group compared with that in the non-HW group (95% confidence interval: 1.2-6.5).ConclusionOur data show that the driving forces for the discrepancy in severity of CD are older age and race/ethnicity. Importantly, the risk for persistent and recurrent CD was higher in minority children.
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Georgakis MK, Papathoma P, Ryzhov A, Zivkovic-Perisic S, Eser S, Taraszkiewicz Ł, Sekerija M, Žagar T, Antunes L, Zborovskaya A, Bastos J, Florea M, Coza D, Demetriou A, Agius D, Strahinja RM, Themistocleous M, Tolia M, Tzanis S, Alexiou GA, Papanikolaou PG, Nomikos P, Kantzanou M, Dessypris N, Pourtsidis A, Petridou ET. Malignant central nervous system tumors among adolescents and young adults (15-39 years old) in 14 Southern-Eastern European registries and the US Surveillance, Epidemiology, and End Results program: Mortality and survival patterns. Cancer 2017; 123:4458-4471. [DOI: 10.1002/cncr.30884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Marios K. Georgakis
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Paraskevi Papathoma
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Department of Neurology; University Hospital; Linköping Sweden
| | - Anton Ryzhov
- National Cancer Registry of Ukraine; National Institute of Cancer; Kiev Ukraine
| | | | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub; Izmir and Hacettepe University Institute of Public Health; Ankara Turkey
| | - Łukasz Taraszkiewicz
- Greater Poland Cancer Registry, Department of Cancer Prevention and Epidemiology; Greater Poland Cancer Center; Poznan Poland
| | - Mario Sekerija
- Croatian National Cancer Registry; Croatian Institute of Public Health; Zagreb Croatia
| | - Tina Žagar
- Cancer Registry of the Republic of Slovenia; Institute of Oncology; Ljubljana Slovenia
| | - Luis Antunes
- North Region Cancer Registry of Portugal; Portuguese Oncology Institute of Porto; Porto Portugal
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology; Childhood Cancer Subregistry of Belarus; Minsk Belarus
| | - Joana Bastos
- Central Region Cancer Registry of Portugal; Portuguese Oncology Institute of Coimbra; Coimbra Portugal
| | - Margareta Florea
- Regional Cancer Registry of Iasi; National Institute of Public Health; Iasi Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj; Ion Chiricuta Oncological Institute; Cluj-Napoca Romania
| | - Anna Demetriou
- Cyprus Cancer Registry, Health Monitoring Unit; Ministry of Health; Nicosia Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research; Valletta Malta
| | - Rajko M. Strahinja
- Cancer Registry, Department for Epidemiology of Noncommunicable Diseases, Center for Disease Prevention and Control; Institute of Public Health; Podgorica Montenegro
| | | | - Maria Tolia
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, School of Medicine; National and Kapodistrian University of Athens; Greece Athens
| | - Spyridon Tzanis
- Neurosurgery Department; Errikos Dunant Hospital Center; Athens Greece
| | - George A. Alexiou
- Neurosurgical Institute; Ioannina University School of Medicine; Ioannina Greece
| | | | - Panagiotis Nomikos
- Department of Neurosurgery and Gamma Knife Radiosurgery; Hygeia Hospital; Athens Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology and Oncology; Panagiotis and Aglaia Kyriakou Children's Hospital; Athens Greece
| | - Eleni T. Petridou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Stockholm Sweden
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Zheng Z, Li X, Zhu Y, Gu W, Xie X, Jiang J. Prognostic nomogram for previously untreated adult patients with acute myeloid leukemia. Oncotarget 2016; 7:71526-71535. [PMID: 27689396 PMCID: PMC5342098 DOI: 10.18632/oncotarget.12245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/19/2016] [Indexed: 12/26/2022] Open
Abstract
This study was designed to perform an acceptable prognostic nomogram for acute myeloid leukemia. The clinical data from 311 patients from our institution and 165 patients generated with Cancer Genome Atlas Research Network were reviewed. A prognostic nomogram was designed according to the Cox's proportional hazard model to predict overall survival (OS). To compare the capacity of the nomogram with that of the current prognostic system, the concordance index (C-index) was used to validate the accuracy as well as the calibration curve. The nomogram included 6 valuable variables: age, risk stratifications based on cytogenetic abnormalities, status of FLT3-ITD mutation, status of NPM1 mutation, expression of CD34, and expression of HLA-DR. The C-indexes were 0.71 and 0.68 in the primary and validation cohort respectively, which were superior to the predictive capacity of the current prognostic systems in both cohorts. The nomogram allowed both patients with acute myeloid leukemia and physicians to make prediction of OS individually prior to treatment.
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Affiliation(s)
- Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China.,Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China
| | - Xiaodong Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, China
| | - Yuandong Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Xiaobao Xie
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Jingting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China
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Georgakis MK, Karalexi MA, Kalogirou EI, Ryzhov A, Zborovskaya A, Dimitrova N, Eser S, Antunes L, Sekerija M, Zagar T, Bastos J, Agius D, Florea M, Coza D, Bouka E, Bourgioti C, Dana H, Hatzipantelis E, Moschovi M, Papadopoulos S, Sfakianos G, Papakonstantinou E, Polychronopoulou S, Sgouros S, Stefanaki K, Stiakaki E, Strantzia K, Zountsas B, Pourtsidis A, Patsouris E, Petridou ET. Incidence, time trends and survival patterns of childhood pilocytic astrocytomas in Southern-Eastern Europe and SEER, US. J Neurooncol 2016; 131:163-175. [PMID: 27743145 DOI: 10.1007/s11060-016-2284-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023]
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49
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Knoble NB, Alderfer MA, Hossain MJ. Socioeconomic status (SES) and childhood acute myeloid leukemia (AML) mortality risk: Analysis of SEER data. Cancer Epidemiol 2016; 44:101-8. [PMID: 27543948 DOI: 10.1016/j.canep.2016.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/31/2022]
Abstract
Socioeconomic status (SES) is a complex construct of multiple indicators, known to impact cancer outcomes, but has not been adequately examined among pediatric AML patients. This study aimed to identify the patterns of co-occurrence of multiple community-level SES indicators and to explore associations between various patterns of these indicators and pediatric AML mortality risk. A nationally representative US sample of 3651 pediatric AML patients, aged 0-19 years at diagnosis was drawn from 17 Surveillance, Epidemiology, and End Results (SEER) database registries created between 1973 and 2012. Factor analysis, cluster analysis, stratified univariable and multivariable Cox proportional hazards models were used. Four SES factors accounting for 87% of the variance in SES indicators were identified: F1) economic/educational disadvantage, less immigration; F2) immigration-related features (foreign-born, language-isolation, crowding), less mobility; F3) housing instability; and, F4) absence of moving. F1 and F3 showed elevated risk of mortality, adjusted hazards ratios (aHR) (95% CI): 1.07(1.02-1.12) and 1.05(1.00-1.10), respectively. Seven SES-defined cluster groups were identified. Cluster 1 (low economic/educational disadvantage, few immigration-related features, and residential-stability) showed the minimum risk of mortality. Compared to Cluster 1, Cluster 3 (high economic/educational disadvantage, high-mobility) and Cluster 6 (moderately-high economic/educational disadvantages, housing-instability and immigration-related features) exhibited substantially greater risk of mortality, aHR(95% CI)=1.19(1.0-1.4) and 1.23 (1.1-1.5), respectively. Factors of correlated SES-indicators and their pattern-based groups demonstrated differential risks in the pediatric AML mortality indicating the need of special public-health attention in areas with economic-educational disadvantages, housing-instability and immigration-related features.
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Bona K, Blonquist TM, Neuberg DS, Silverman LB, Wolfe J. Impact of Socioeconomic Status on Timing of Relapse and Overall Survival for Children Treated on Dana-Farber Cancer Institute ALL Consortium Protocols (2000-2010). Pediatr Blood Cancer 2016; 63:1012-8. [PMID: 26913850 DOI: 10.1002/pbc.25928] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/08/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Population-based evidence suggests that lower socioeconomic status (SES) negatively impacts the overall survival (OS) of children with leukemia; however, the relationships between SES and treatment-related mortality, relapse, and timing of relapse remain unclear. PROCEDURE We examined OS, event-free survival (EFS) and cumulative incidence (CI) and timing of relapse by community-level poverty for 575 children aged 1-18 years with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter Dana-Farber Cancer Institute ALL Consortium Protocols between 2000 and 2010. Children were categorized into high- and low-poverty areas for the analysis using aggregate U.S. Census data linked to zip code. RESULTS Children living in high-poverty areas experienced a 5-year OS of 85% as compared with 92% for those in low-poverty areas (P = 0.02); poverty remained marginally significant (P = 0.07) after adjustment for immunophenotype, age, and white blood cell count. There were no differences detected in EFS or CI relapse by poverty area. However, 92% of the relapses observed in children from high-poverty areas occurred <36 months from complete remission, compared to 48% of those in children from low-poverty areas (P = 0.008). CONCLUSIONS U.S. children with ALL living in high-poverty areas have a higher risk of early relapse when compared with those living in low-poverty areas despite uniform treatment. This may in part explain decreased OS observed in these children. This finding highlights disparities in childhood cancer outcomes by SES despite uniform treatment. Further investigations of the mechanistic pathways underlying this finding are needed.
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Affiliation(s)
- Kira Bona
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna S Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lewis B Silverman
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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