Leukemia is a common cancer among children, with Acute Lymphoblastic Leukemia (ALL) being the most prevalent subtype. Although medical advancements have significantly increased the rate of survival for children with ALL, living in poverty can lead to adverse effects on treatment and relapse rates. Research has shown that children with ALL living in extreme poverty are at a two-fold greater risk of relapse, indicating the need for more attention and resources towards improving healthcare accessibility for these vulnerable populations.
Children with acute lymphoblastic leukemia (ALL) living in extreme poverty and undergoing maintenance therapy are almost twice as likely to suffer relapse compared to those who are not as poor, according to a study published in Blood. Moreover, many of these impoverished children had difficulty adhering to treatment, a finding that only partially explains the link between poverty and the risk of relapse. Previously, research has relied on community measures of poverty to determine poverty’s effect on relapse rates among children with ALL. However, this study is the first to look at the effect of individual-level poverty using annual household income.
The study, conducted by the Division of Pediatric Hematology/Oncology at the University of Alabama at Birmingham, found that while the proportion of relapses in total was relatively low, children living in extreme poverty, whose families were stretched thin and unable to make ends meet, had a higher risk of relapse, even after controlling for all other biologic and prognostic factors. Poverty, like other social determinants of health, was on par with some clinical measures used to risk stratify patients. Children living in extreme poverty were significantly more likely to be nonadherent to prescribed treatment, making it even more critical to identify patients with this level of financial hardship and connect them to resources.
ALL is the most common childhood cancer, and more than half of ALL cases occur in children. Five-year survival rates for ALL now approach 90% thanks to advances in treatment, though this is not true for or equitable across all children, according to Aman Wadhwa, MD, MSPH, pediatric oncologist and health sciences researcher and study lead author.
The findings underscore the requirement for interventions that assess and develop tailored solutions to guarantee equitable access to care. The study is limited by a relatively small sample size and was conducted before measurable residual disease became a routine part of clinical care. Nevertheless, the results provide the foundation for future research into other social determinants of health and their potential role in childhood cancers, as well as interventions to address these barriers.
In conclusion, it is vital to understand the enormous challenges that children with ALL living in extreme poverty face when it comes to cancer treatment. Their risk of relapse is two times higher than that of their more economically stable peers, and this highlights the urgent need for intervention and support. While this is no doubt a challenging issue, there are solutions out there that can help to alleviate the burden for families and children affected by this devastating disease. From increased access to treatment and supportive care to programs aimed at reducing poverty and improving the quality of life for those living in extreme economic circumstances, there is much that can be done to make a positive difference in the world of childhood cancer. With time, effort, and a collective commitment to fighting this disease and its impact, we can help to improve the outcomes and experiences of all children with ALL, regardless of their financial circumstances. So, we must take action now, to give these children a fair chance of fighting cancer and living the life they deserve.
