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Impact of Socioeconomic Status on Timing of Relapse and Overall Survival for Children Treated on Dana‐Farber Cancer Institute ALL Consortium Protocols (2000–2010)
Author(s) -
Bona Kira,
Blonquist Traci M.,
Neuberg Donna S.,
Silverman Lewis B.,
Wolfe Joanne
Publication year - 2016
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25928
Subject(s) - medicine , poverty , socioeconomic status , demography , population , cumulative incidence , cancer , incidence (geometry) , gerontology , pediatrics , cohort , environmental health , sociology , economics , physics , optics , economic growth
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.