How might poverty impact childhood cancer?
That’s the question pediatric oncologist Dr. Kira Bona, a researcher at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, set out to answer.
Her findings: Even with the same medical treatment, children with leukemia living in high-poverty areas were more likely to suffer an early relapse compared to their wealthier counterparts. The research, published this week in the journal Pediatric Blood & Cancer, is important, Bona says, because earlier relapses of this particular cancer — the most common pediatric cancer, called acute lymphoblastic leukemia — are harder to treat successfully.
We already know poverty is bad for your overall health. Among children, Bona says, poor kids tend to have worse underlying health, and higher rates of hospitalization, infectious disease and risk of death compared to more affluent children.
When it comes to cancer treatment though, for the 15,000 American children diagnosed with cancer every year, most are enrolled in clinical trials and treated using similar protocols, Bona said. Still, she said: “Historically, in pediatric oncology, we haven’t included social determinants of health, like poverty and education, as part of the data we collect in clinical trials; we’ve had an almost exclusive focus on biology.”
But since about 20 percent of kids in the U.S. live in poverty, Bona says, that non-biological data is also critical.
I spoke with Bona more about the latest research. Here, edited, is some of our discussion:
What’s the bottom-line finding here?
We looked at 10 years of data; 575 kids ages 1-18 who were treated at major academic medical centers around the U.S, with uniform therapy as part of the same two consecutive clinical trials. We went back and analyzed disease outcome data — overall survival and relapse data — with the question: Does poverty impact these disease outcomes? We used a proxy for poverty, zip codes linked to U.S. census data, to determine high-poverty or low-poverty areas.
We did not see a significant difference in overall survival between high-poverty and low-poverty groups. Additionally, we did not find a significant difference in relapse rates. But we did see a significant difference in the timing of relapse. And the timing of relapse is important, because if you experience an early relapse it’s harder for us to ultimately cure you. Continue reading