Unequal Cancer: Leukemia Study Finds Children In Poverty Face Earlier Relapse

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

Saving Nalini: Leading Psychologist Seeks Bone Marrow Donor To Survive

Prof. Nalini Ambady, whose survival depends on finding a bone marrow donor in the coming weeks, with her daughters. (Courtesy)

Nalini Ambady, whose survival depends on finding a bone marrow donor in the coming weeks, with her daughters. (Courtesy)

Psychology professor Nalini Ambady, formerly of Harvard and Tufts and now at Stanford, has leukemia and just weeks to live unless she finds a bone-marrow donor who matches her, most likely one of South Asian descent. Her family and friends in academia and beyond are mounting an extraordinary public effort to save her, including attempts to use the findings of her field — social psychology — to motivate potential donors. (See, for example, this Psychology Today post: Point. Click. Save This Woman’s Life.) Here, Dr. Liz Gaufberg, of Harvard Medical School and Cambridge Health Alliance, shares her own plea with the public to help.

By Liz Gaufberg, MD
Guest contributor

This April vacation, my husband and our teenaged daughters decided we needed a true break. We booked a beach resort and made a pact to unplug. No cell phone. No texting. No Facebook. No Internet. No TV. We’d read books, eat meals together and talk about what matters to us. We made only one exception to the no-technology rule: Nalini.

My dear friend Nalini is in a race against time with leukemia – searching, hoping, waiting for a bone marrow donor to save her life. I am in the habit of speaking with Nalini almost every day. Everyone agreed I would be allowed to go to the hotel lobby to email her and visit her CaringBridge Site. If Nalini took a turn for the worse, I would leave our vacation early.

Day one of vacation went just as planned. Over dinner we chided each other about sunscreen and talked about the books we had cracked. Our 13 year old adored The Sisterhood of the Traveling Pants. I read Nathan Englander’s book of short stories “What We Talk about When We Talk about Anne Frank.” The title story turns on a game that a contemporary suburban American Jewish couple plays. The game is a thought experiment they call “Who Will Hide Me?”


Professor Nalini Ambady last summer (courtesy)

They run through a list of non-Jewish friends and acquaintances and imagine — in the event of another Holocaust — what each individual would do. Is this someone who would risk his or her own life and family to save us? Would they turn us in? After initial teen protests that the game was “morbid” and complaints about a Mom who never talks about “normal stuff,” we played a few rounds at the table. What about that nice neighbor who digs our car out in the winter, would he? The bagger at Stop and Shop, would she? What would we do if someone needed us?

The game came to an abrupt end when we overhead a woman at the next table talking about our home city of Boston. Had we heard correctly? Yes. Two bombs had exploded at the Marathon. Back in our room, we quickly plugged in the TV. After bomb number one exploded, it looked at first like chaos, with people running in all directions. But as we watched, we realized…some people were actually running toward the explosion while others were running away. What would I do? Would I run in and try to help or would I clutch my children and run away? So much for our brief self-imposed ban on technology; it was the only way to find out how we might support and help, even from afar.

Our dinner table talk about saving the lives of strangers turned to saving Nalini. Nalini Ambady, a professor of Psychology at Stanford, needs to find a bone marrow donor in the next few weeks in order to survive. A match for Nalini will most likely come from someone from Nalini’s birthplace — Kerala, in Southern India. Unfortunately, the percentage of South Asians on the U.S. Bone Marrow Registry is dismally low. A South Asian like Nalini has a 1-in-20,000 chance of finding a match, while for Caucasian recipients the chance is 1 in 8. Continue reading