Improving Pediatric Cancer Care Disparities Across the United Statesâ€“Mexico Border: Lessons Learned from a Transcultural Partnership between San Diego and Tijuana

Aristizabal, Paula; Fuller, Spencer; Rivera, Rebeca; Beyda, David H.; Ribeiro, Raul C.; Roberts, William

doi:10.3389/fpubh.2015.00159

Cited by 23 publications

(31 citation statements)

References 25 publications

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“…Biologic factors contributing to health disparities in the United States include differences in genomic/cytogenetic profiles, altered drug metabolism, and differences in chemotherapeutic response. Non‐biologic factors include SES, insurance access, demographic location, and environmental exposures, among others 6,47,54,55 . The latter may be particularly relevant to the Texas/Chihuahua border, a former site of the American Smelting and Refining Company, which has been associated with increased cancer incidence in Washington, Arizona, and Montana 56‐63 .…”

Section: Discussionmentioning

confidence: 99%

Ethnic and border differences on blood cancer presentation and outcomes: A Texas population‐based study

Bencomo‐Alvarez

Gonzalez

Rubio

et al. 2020

Cancer

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Background The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population‐based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. Methods Data from the Texas Cancer Registry (1995‐2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non‐Hispanic) and geographic location (border vs non‐border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel‐Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. Results Hispanic patients were diagnosed at a younger age than non‐Hispanic patients and presented with increased comorbidities. Whereas non‐Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79‐2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07‐1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04‐1.33; P = .0009) compared with Hispanics living elsewhere in Texas. Conclusions Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.

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Section: Discussionmentioning

confidence: 99%

Ethnic and border differences on blood cancer presentation and outcomes: A Texas population‐based study

Bencomo‐Alvarez

Gonzalez

Rubio

et al. 2020

Cancer

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“…In 2007, stakeholders at St. Jude Children's Research Hospital (St. Jude, Memphis, TN, USA), Rady Children's Hospital (San Diego, CA, USA) and the Hospital Tijuana implemented a partnership to establish a pediatric oncology program 17 aimed at improving clinical outcomes and survival of children with cancer in the Mexican State of Baja California. Several initiatives have been added since the start of the project, including a robust infection prevention and control program.…”

Section: Methodsmentioning

confidence: 99%

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

Torres

González

Loera

et al. 2016

American Journal of Infection Control

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Background The U.S. National Healthcare Safety Network (NHSN) has provided a definition of mucosal barrier injury–associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its impact in pediatric oncology centers in low- to middle-income countries. Objectives To determine the impact of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI vs. non-MBI LCBI cases. Methods We retrospectively applied the NHSN definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were re-classified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. Results Of 55 CLABSI events, 44% (24/55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72 to 3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P=0.029) and had a significantly greater frequency of neutropenia (100% vs. 39%, P=0.001) and chemotherapy exposure (87% vs. 58%, P=0.020) and significantly longer median hospitalization (34 vs. 23 days, P=0.008). Conclusion A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI– -LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.

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“…Specifically, the relative contributions of social determinants of health associated with the social construct of racial/ethnic minority status (e.g., structural racism impacting socioeconomic status, education, access to health care, and basic resource needs) and genetic ancestry-associated pharmacogenomic differences 73,74 that may drive treatment efficacy or toxicity remain unclear. It is notable that similar analyses at St. Jude Children's Research Hospital for acute lymphoblastic leukemia between 1991 and 1998 75 [87][88][89][90] Global pediatric cancer programs are desperately needed to reduce survival gaps in low-and middle-income countries. Key components of such programs include financial coverage, accreditation of pediatric cancer centers, mandatory case registration and reporting, and the creation of national standards of care and pediatric cancer-governing bodies.…”

Section: Barriers and Enablers To Adequate Informed Consent In Minority Parents Of Children With Cancermentioning

confidence: 99%

Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer

Aristizabal

Winestone

Umaretiya

et al. 2021

American Society of Clinical Oncology Educational Book

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Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.

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Improving Pediatric Cancer Care Disparities Across the United Statesâ€“Mexico Border: Lessons Learned from a Transcultural Partnership between San Diego and Tijuana

Cited by 23 publications

References 25 publications

Ethnic and border differences on blood cancer presentation and outcomes: A Texas population‐based study

Ethnic and border differences on blood cancer presentation and outcomes: A Texas population‐based study

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer

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