Investigators have found that pediatric patients with acute lymphoblastic leukemia (ALL) who lived along the Texas-Mexico border were more likely to die within 5 years than those living in other areas of the state, according to a new study published by Castellanos et al in Cancer.
Background
Individuals living along the Texas-Mexico border—consisting of a mixture of rural and urban communities—are known to be medically underserved. Survival disparities for these populations have been observed in adults diagnosed and treated for various malignancies, but information on pediatric cancer outcomes is lacking.
Study Methods and Results
In the new study, investigators conducted a retrospective survival analysis involving 6,002 pediatric patients with ALL and 1,279 pediatric patients with acute myeloid leukemia (AML) using data from the Texas Cancer Registry between 1995 and 2017.
Among the pediatric patients with ALL, the proportion of those who survived for at least 5 years after diagnosis was lower in patients living along the border regions (77.5%) compared with those living in nonborder areas (85.8%). After adjusting for other factors known to impact survival—such as age at diagnosis, sex, and socioeconomic status—pediatric patients with ALL living along the border experienced a 30% higher risk of mortality compared with those living elsewhere in Texas. In contrast, for children with AML, survival estimates did not vary by border vs nonborder residence.
Conclusions
“While there have been tremendous achievements in maximizing cure rates for [pediatric patients] with leukemia in the United States, not everyone is benefiting from these advances. We know there are differences in survival, with [pediatric patients] from historically marginalized Hispanic and Black communities faring worse than White [pediatric patients],” said Maria Castellanos, MD, Assistant Professor of Pediatric Hematology Oncology at the University of California, San Francisco School of Medicine. “There is an urgent need to identify the reasons why these differences in survival are occurring, including an assessment of the barriers to obtaining health care and strategies to successfully reduce barriers,” she concluded.
“We urgently call for the attention of public health leaders and health-care providers in both the [United States] and Mexico to mitigate the health disparities suffered by immigrants, a population that plays a vital role for the economies and social fabric of these two countries,” emphasized Paula Aristizabal, MD, MAS, Associate Professor of Pediatric Hematology Oncology at the University of California, San Diego, and a hematologist-oncologist at Rady Children’s Hospital–San Diego. In an accompanying editorial, Dr. Aristizabal and coauthors stressed that officials need to work to improve cancer outcomes in rural areas with concentrated poverty.
The investigators noted that additional studies are urgently needed to identify factors that may be contributing to health-care disparities for pediatric patients with ALL living along the Texas-Mexico border.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
