Impact of Insurance Status on Survival Outcomes in Adults With Acute Lymphoblastic Leukemia (ALL): A Single-center Experience

Krakora, Rebecca; Shih, Weichung Joe; Popli, Pallvi; Gorshein, Elan; Salaru, Gratian; Moore, Dirk F.; Chen, Chunxia; David, Kevin A.; Bannerji, Rajat

doi:10.1016/j.clml.2020.06.010

Cited by 9 publications

(7 citation statements)

References 32 publications

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“…Furthermore, in SEER data, SES as measured at the neighborhood level significantly mediated the association between race/ethnicity and childhood ALL survival, leading to a 44% reduction from the total to the direct effect of the Black-NHW survival disparity and 31% reduction of the Hispanic/Latino-NHW disparity in survival [175] . The inferior outcomes in high poverty neighborhoods might be attributable to multiple elements, including a poor adherence to therapy (e.g., long-term oral administration of antimetabolites) [176,177] , lack of insurance, and the discontinuous coverage of insurance [178][179][180] .…”

Section: Socioeconomic Status and All Risk And Survivalmentioning

confidence: 99%

Disparities in acute lymphoblastic leukemia risk and survival across the lifespan in the United States of America

Xu¹,

Feng²,

Smith³

2021

jtgg

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Acute lymphoblastic leukemia (ALL) is the most common childhood cancer but is less frequent in adolescents and young adults (AYAs) and is rare among older adults. The 5-year survival of ALL is above 90% in children, but drops significantly in AYAs, and over half of ALL-related deaths occur in older adults. In addition to diagnosis age, the race/ethnicity of patients consistently shows association with ALL incidence and outcomes. Here, we review the racial/ethnic disparities in ALL incidence and outcomes, discuss how these vary across the age spectrum, and examine the potential causes of these disparities. In the United States, the incidence of ALL is highest in Hispanics/Latinos and lowest in Black individuals across all age groups. ALL incidence is rising fastest in Hispanics/Latinos, especially in AYAs. In addition, survival is worse in Hispanic/Latino or Black ALL patients compared to those who are non-Hispanic White. Different molecular subtypes of ALL show heterogeneities in incidence rates and survival outcomes across age groups and race/ethnicity. Several ALL risk variants are associated with genetic ancestry, and demonstrate different risk allele frequencies and/or effect sizes across populations. Moreover, non-genetic factors including socioeconomic status, access to care, and environmental exposures all likely influence the disparities in ALL risk and survival. Further studies are needed to investigate the potential joint effects and interactions of genetic and environmental risk factors. Improving survival in Hispanic/Latino and Black patients with ALL requires advances in precision medicine approaches, improved access

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Section: Socioeconomic Status and All Risk And Survivalmentioning

confidence: 99%

Disparities in acute lymphoblastic leukemia risk and survival across the lifespan in the United States of America

Xu¹,

Feng²,

Smith³

2021

jtgg

View full text Add to dashboard Cite

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“…One commonality between the four leukemias is that the Hispanic population tends to be diagnosed at a younger age compared with non-Hispanics (Hallek et al, 2010;Jain et al, 2017;Kahn et al, 2016b;Krakora et al, 2020;Nabhan et al, 2014;Patel et al, 2013;Patel et al, 2012;Patel et al, 2015;Pulte et al, 2013;Sarmad et al, 2017;Shoag et al, 2020), and we have confirmed these findings in a population residing near the U.S./Mexico border (Bencomo-Alvarez et al, 2020). The Hispanic population in the U.S. is generally younger than the non-Hispanic population (Schaeffer, 2019); therefore, mortality rates from cancer or other diseases associated with advanced ages are lower in Hispanics.…”

Section: Factors That Contribute To Health Disparitiesmentioning

confidence: 99%

“…In adults, Hispanics diagnosed with ALL are diagnosed at a younger age compared with NHWs, demonstrating a higher incidence rate and more dismal prognoses. Specifically, Hispanic ALL patients demonstrate significantly worse overall survival (OS) and progression-free survival rates, as well as higher mortality in age-adjusted analyses ( Patel et al 2012 ; Pulte et al 2013 ; Kahn et al 2016b ; Jain et al 2017 ; Krakora et al 2020 ; Shoag et al 2020 ). Our own research in Texas has confirmed these findings, showing that Hispanic ALL patients are diagnosed at a significantly younger age, have higher incidence rates (RR, 1.92; 95% CI, 1.79–2.08; P < 0.001), and worse OS compared with NHWs.…”

Section: Acute Leukemiasmentioning

confidence: 99%

“…In addition to the factors listed above, lack of insurance is a major problem in minority groups. Recent data shows that 72% of the Hispanic population in the United States has no health insurance, compared with just 10% of the remaining population ( Krakora et al 2020 ). A lack of private health insurance influences access to critical therapies like allogeneic hematopoietic stem cell transplantation (allo-HSCT), one of the only curative treatment approaches available for blood cancer patients.…”

Section: Factors That Contribute To Health Disparitiesmentioning

confidence: 99%

“…Reduced clinical trial enrollment and reduced access to treatment at comprehensive cancer centers across the United States also contribute to these cancer health disparities ( Krakora et al 2020 ). Our own observations suggest that residence near the U.S./Mexican border is associated with worse outcomes; thus, regional location also plays a role ( Bencomo-Alvarez et al 2020 ).…”

Section: Factors That Contribute To Health Disparitiesmentioning

confidence: 99%

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Blood cancer health disparities in the United States Hispanic population

Bencomo‐Alvarez

Rubio

Gonzalez

et al. 2021

Cold Spring Harb Mol Case Stud

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Cancer is a challenging, multifaceted disease that involves a combination of biological and non-biological factors. Aside from COVID-19, cancer is the second leading cause of death in the United States (U.S.), and the first among Hispanic Americans. The Hispanic population is the largest minority group in the U.S., which is rapidly growing in size. Unfortunately, U.S. Hispanics and other minority groups experience many different health disparities, resulting in poor survival outcomes and a reduced quality of life. Factors such as genomic mutations, lower socioeconomic status, lack of education, reduced access to health care, comorbidities, and environmental factors all contribute to these health care inequalities. In the context of blood cancer health disparities, Hispanic patients are often diagnosed at a younger age and have worse outcomes compared with non-Hispanic individuals. In the present article, we highlight the existing knowledge about cancer health disparities in the Hispanic population, with a focus on chronic and acute leukemia. In our experience at the U.S./Mexico border, analysis of several different blood cancers demonstrated that younger Hispanic patients with acute lymphoid or myeloid leukemia have higher incidence rates and worse prognoses. A combined approach, involving improved health care access and better knowledge of the underlying factors, will allow for more timely diagnoses and the development of intervention strategies aimed at reducing or eliminating the disparities.

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Survival Outcomes in Older Adult Acute Lymphoblastic Leukemia Patients Analyzed by Facility Volume and Type: A National Cancer Database Analysis

Dykes,

Chou,

Taylor

et al. 2024

Cancer Reports

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BakgroundIt is important to understand the outcomes of adult acute lymphoblastic leukemia (ALL) patients at different facilities as treatment paradigms change.AimsOur primary objective was to determine adult ALL overall survival (OS) by facility volume and type. Secondary objectives included identifying sociodemographic factors that may have impacted outcomes and analyzing treatment patterns by facility volume and type.MethodsThis was a retrospective analysis of the National Cancer Database (NCDB) that included patients ≥40 years diagnosed with ALL between 2004 and 2016.ResultsA total of 14 593 patients were included in this study. Univariate OS was greatest at low volume (LV) and community programs (CPs) and the least at high volume (HV) and academic programs (AP). This difference was lost after multivariable Cox proportional hazards model analysis, which found no difference in survival by facility volume or type, however, survival was significantly influenced by age, race, Hispanic ethnicity, insurance, and residence location (p < 0.05). Patients treated at HV and APs compared to LV and CP received more anti‐neoplastic directed therapy.ConclusionOur results suggest treatment facility volume and type do not impact older adult ALL patient (≥40 years) survival, however confounding sociodemographic differences do impact survival outcomes, despite more aggressive and novel treatment approaches provided at HV and APs.

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Impact of Insurance Status on Survival Outcomes in Adults With Acute Lymphoblastic Leukemia (ALL): A Single-center Experience

Cited by 9 publications

References 32 publications

Disparities in acute lymphoblastic leukemia risk and survival across the lifespan in the United States of America

Disparities in acute lymphoblastic leukemia risk and survival across the lifespan in the United States of America

Blood cancer health disparities in the United States Hispanic population

Survival Outcomes in Older Adult Acute Lymphoblastic Leukemia Patients Analyzed by Facility Volume and Type: A National Cancer Database Analysis

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