Disparities found to affect survival for older children, adolescents and young adults with acute myeloid leukemia

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New study from the Cancer Prevention Institute of California finds lower survival rate for blacks and those treated at centers not affiliated with the National Cancer Institute.

Renata Abrahão MD, MSc

Renata Abrahão MD, MSc

“Our study reveals that survival inequalities persist among vulnerable patients with acute myeloid leukemia such as the uninsured, those of black race/ethnicity and adolescents and young adults.” said Renata Abrahão MD, MSc.

Acute leukemia is the leading cause of cancer death among patients 39 years of age and younger. Without treatment, most patients die within months, if not weeks, of diagnosis. The five-year survival was only about 50% for the most recent treatment period of 2004 – 2011.

In a study led by the Cancer Prevention Institute of California(CPIC) and the London School of Hygiene and Tropical Medicine, and published in the February issue of the British Journal of Hematology, researchers analyzed 3,935 patients with acute myeloid leukemia (AML) up to 39 years of age in California from 1988 – 2011.

For this study researchers used data from the California Cancer Registry, which participates in the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI). To the authors’ knowledge, this is the first population-based study that simultaneously examined the influence of race/ethnicity, neighborhood socioeconomic status, type of health insurance and treatment facility on survival.

Researchers found several subgroups of patients with worse survival. They tended to fall into one of these groups:

  •     age group (10 – 39 years)
  •     lower neighborhood socioeconomic status
  •     black race/ethnicity
  •     receipt of initial care in hospitals not affiliated with the NCI
  •     lack of health insurance

The diagnosis of AML in older children, adolescents and young adults may require more intensive treatment, which may lead to a higher probability of treatment-related complications. Older children, adolescents and young adults are also less likely to participate in clinical trials and more likely to receive treatment at hospitals not affiliated with the NCI in comparison to younger children.

A significant association was found between lower socioeconomic neighborhoods and early death suggesting that these patients lacked access to optimal treatments during the critical days after initial diagnosis.

It is not clear what factors accounted for the disparities in survival among black patients. Researchers speculate that genetics may contribute to the difference in chemotherapy response or that black patients had less access to chemotherapy and other treatments such as hematopoietic stem cell transplantation.

Recent studies have also shown the biology of pediatric AML differs from adult AML which may lead to a favorable prognosis in younger patients.

Researchers also found evidence of increased early death and lower survival among uninsured patients compared to privately or publicly insured patients. Health insurance information was available in the California Cancer Registry for patients diagnosed from 1996 – 2011.

“Our study reveals that survival inequalities persist among vulnerable patients with acute myeloid leukemia such as the uninsured, those of black race/ethnicity and adolescents and young adults.” said Renata Abrahão MD, MSc, a visiting research scientist at CPIC and lead author of the study. “This study can serve as a baseline to compare changes in survival that may result from potential improvements in health insurance coverage following the implementation of the Affordable Care Act (Obamacare).”

“Moreover, this study showed that survival after AML remains low among young patients and highlights the need for new therapeutic regimens to treat this disease with various subtypes. We emphasized the importance of linking population-based data with genetic and clinical information contained in the patients’ medical records in order to better understand the causes of survival inequalities.”

The work was supported by Children with Cancer UK.

Authors include: Renata Abrahão of the Cancer Prevention Institute of California and the Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine; Ruth Keogh of the Department of Medical Statistics, London School of Hygiene and Tropical Medicine; Daphne Lichtensztajn of the Cancer Prevention Institute of California; Rafael Marcos-Gragera of the Epidemiology Unity and Cancer Registry of Girona, Girona Biomedical Research Institute; Bruno Medeiros of the Division of Hematology, Stanford University School of Medicine; Michel Coleman of the Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine; Raul Ribeiro of the Department of Oncology, Leukemia and Lymphoma Division, St. Jude Children’s Research Hospital, and Theresa H.M. Keegan in the Division of Hematology and Oncology at the University of California, Davis.

About the Cancer Prevention Institute of California
The Cancer Prevention Institute of California is the nation’s premier organization dedicated to preventing cancer and to reducing its burden where it cannot yet be prevented. CPIC tracks patterns of cancer throughout the entire population and identifies those at risk for developing cancer. Its research scientists are leaders in investigating the causes of cancer in large populations to advance the development of prevention-focused interventions. CPIC’s innovative cancer prevention research and education programs, together with the work of the Stanford Cancer Institute, can make our vision of a world without cancer a reality. For more information, visit CPIC’s official website at http://www.cpic.org.

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