Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Abstract

Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients’ database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata ( P =0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent ( P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 ( P =0.015); 1.98 ( P =0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children

“…stated that more than 90% of global childhood deaths from cancer occur in low- and middle-income countries with a striking disparity of cancer survival rates as compared to high-income countries with a mean 5-year survival rate of 20%. [ 21 22 ] Pediatric cancers have been seen to affect the middle and lower socioeconomic class more significantly,[ 23 ] which was similar to our observations, wherein the middle class (43%) and lower class (41%) were affected more than the upper class (16%).…”

The Unique Balancing Act of Managing Children With Cancer and COVID-19 Infection: A Single Center Experience From South India

“…The concern of developing a severe COVID-19 illness has a significant impact on the initiation and continuation of cytotoxic therapy in children with cancer. Because of the paucity of centers that manage children with cancer, patients residing in LMICs often travel long distances for treatment 16. The regulations on travel and routine medical services to curtail the spread of COVID-19 hinder patients from receiving appropriate treatment.…”

“…Because of the paucity of centers that manage children with cancer, patients residing in LMICs often travel long distances for treatment. 16 The regulations on travel and routine medical services to curtail the spread of COVID-19 hinder patients from receiving appropriate treatment. Our study has elucidated the clinical profile of a sizeable cohort of children with cancer who acquired COVID-19 and the adaptations made to continue their primary treatment.…”

The Fragile Web of Care: Ethnicity, Poverty, and Language in Acute Leukaemia

“…Californian children with ALL living in a neighbourhood with lower socioeconomic status (SES) had a 39% higher risk of death compared with children living in high SES areas within the same state 2 . Lower SES also predicted inferior survival in a paediatric ALL cohort in India, 5 an adult ALL cohort in England, 6 and an adult AML cohort in France 7 …”