Abstract IA12: Poverty and pediatric leukemia outcomes

Abstract

Abstract Novel efforts to identify and address residual drivers of morbidity and mortality in pediatric cancer are essential. Poverty, in addition to biology, is emerging as a target for improvement in childhood cancer outcomes. While population-based evidence has suggested that poverty negatively impacts overall survival (OS) in childhood leukemia, limited data have explored the relationship between poverty and disease outcomes in the standardized care setting of clinical trials. Furthermore, measures of poverty amenable to targeted intervention have not been previously described in the pediatric oncology setting. We examined overall survival (OS), event-free survival (EFS), and cumulative incidence and timing of relapse by community-level poverty for 575 children with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter consortium protocols between 2000-2010. Children were categorized as living in a high- or low-poverty area using aggregate U.S. Census data linked to zip code. Children from high-poverty areas experienced inferior OS as compared to those in low-poverty areas (85% vs. 92%, p=0.02), which remained marginally significant after adjustment for NCI risk criteria. Among children who relapsed, children from high-poverty areas were significantly more likely to experience early relapse (<36 months in complete remission; 92% vs 48%, p=0.008), which is more challenging to salvage. These data identified poverty-related disparities in childhood leukemia outcomes, suggesting a need for further investigation of poverty measures amenable to intervention. We subsequently sought to describe the prevalence of a concrete measure of poverty termed household material hardship (HMH)--defined as food, energy, and housing insecurity--in a cohort of newly diagnosed pediatric oncology families. HMH in primary care is associated with inferior health outcomes, remediable with targeted intervention, and associated with improved health outcomes when remediated. We conducted a single-site prospective cohort study of 99 families of newly diagnosed pediatric cancer families receiving chemotherapy. We found that 20% of families reported pre-existing HMH at the time of diagnosis, and 29% of families reported HMH following 6 months of chemotherapy despite existing psychosocial supports. These data suggest that a quantifiable and remediable measure of poverty is present in a significant proportion of children undergoing cancer therapy in the U.S. and represents a potential target for future intervention. Citation Format: Kira Bona. Poverty and pediatric leukemia outcomes [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA12.