COVID Extension: Material Hardship as a Targetable Measure of Poverty in Pediatric Cancer

COVID 扩展：物质困难作为小儿癌症贫困的有针对性的衡量标准

• 批准号: 10451029
• 负责人: Kira O. Bona
• 金额: $ 6.34万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10451029
• 关键词: Achievement; Acute Lymphocytic Leukemia; Address; Adherence; Affect; Biological; Caring; Child; Child Health; Childhood Acute Lymphocytic Leukemia; Clinical Data; Clinical Trials; Data; Development; Diagnosis; Dimensions; Disease; Disease Outcome; Dose; Elements; Enrollment; Family; Food; Future; Health Services Accessibility; Health Status; Hospitalization; Household; Housing; Inferior; Intervention; Interview; Link; Malignant Childhood Neoplasm; Malignant Neoplasms; Measures; Mentorship; Methods; Modeling; Morbidity - disease rate; Multi-Institutional Clinical Trial; Newly Diagnosed; Oral; Outcome; Parents; Patterns of Care; Phase; Poverty; Provider; Relapse; Residual state; Resources; Risk; Surveys; Toxicity due to chemotherapy; United States; Work; base; cancer care; chemotherapy; childhood cancer mortality; coronavirus disease; experience; improved; leukemia; leukemia relapse; mortality; pediatric health outcomes; prospective; risk stratification; social health determinants; standardized care; survival disparity; therapy design

PROJECT SUMMARY The objective of the proposed study is to reduce residual morbidity and mortality in pediatric cancer by laying the groundwork for the design of interventions targeting social determinants of health outcomes, specifically poverty. Sequential clinical trials have resulted in steady improvements in survival for children with acute lymphoblastic leukemia (ALL) through incremental advancements in risk stratification and risk-adapted therapy. Despite this achievement, approximately 20% of children with ALL will relapse and 10% will die of their disease making ALL the leading cause of childhood cancer death. One in five children in the United States lives in poverty. Emerging data demonstrate that despite highly standardized care, poverty-related survival disparities exist in childhood ALL in the United States. Mechanisms underlying this relationship have not been defined, nor have targetable domains of poverty been investigated. The hypothesis underlying this proposal is that improved child cancer outcomes are achievable by integrating remediable domains of poverty into risk stratification and developing poverty-targeted interventions. Household material hardship (HMH)—unmet concrete resource needs including food, housing or energy—is a dimension of poverty which predicts general pediatric health outcomes and can be remedied by intervention. A majority of U.S. children diagnosed with acute lymphoblastic leukemia (ALL), the most common childhood cancer, will enroll on a clinical trial. This trial-based paradigm of discovery and care has allowed for steady improvements in biologically-based risk stratification and risk-adapted therapy. This proposal leverages an existing clinical trials model of care to investigate the impact of a non-biologic driver of outcome. The specific hypothesis is that HMH impacts pediatric ALL relapse and survival through three mechanisms affecting chemotherapy delivery: (1) Decreased adherence to oral chemotherapy, (2) Inferior underlying child health status leading to chemotherapy toxicity and subsequent delays/dose reductions, and (3) Decreased access to care leading to higher acuity hospital admissions which delay chemotherapy receipt. Building on her pilot work and leveraging the cross-disciplinary expertise of her mentorship team in a mixed methods approach, Dr. Bona proposes to assess whether HMH is associated with inferior disease outcomes in pediatric ALL, and to identify potential mechanisms of action which can be targeted with future interventions. In Aims 1-3) Dr. Bona will embed a prospective survey study of HMH in a phase III multi-center clinical trial for children with newly diagnosed ALL to identify the association between HMH and rates of early relapse and survival (Aim 1), oral chemotherapy adherence (Aim 2a), chemotherapy delivery (Aim 2b) and patterns of care (Aim 3). In Aim 4) Dr. Bona will utilize parent and provider interviews to identify targetable elements in the experience of HMH to inform the development of an HMH intervention for the clinical trial setting.

项目概要 拟议研究的目的是通过降低儿童癌症的残余发病率和死亡率 设计针对健康结果社会决定因素的干预措施的基础，特别是 贫困。连续的临床试验已使患有急性疾病的儿童的生存率稳步提高。 通过风险分层和风险适应治疗的不断进步，预防淋巴细胞白血病（ALL）。 尽管取得了这一成就，但大约 20% 的 ALL 儿童会复发，10% 会死于疾病 使 ALL 成为儿童癌症死亡的主要原因。美国五分之一的儿童居住在 贫困。新数据表明，尽管护理高度标准化，但与贫困相关的生存差距 ALL 存在于美国的童年时期。这种关系背后的机制尚未确定， 也没有对目标贫困领域进行调查。该提案的假设是 通过将可补救的贫困领域纳入风险范围，可以改善儿童癌症的结果 分层并制定针对贫困的干预措施。家庭物质困难（HMH）——未满足 具体的资源需求，包括食物、住房或能源——是贫困的一个方面，它预示着普遍的贫困 儿科健康结果，可以通过干预来补救。 大多数美国儿童被诊断患有急性淋巴细胞白血病 (ALL)，这是最常见的儿童期疾病 癌症，将参加临床试验。这种基于试验的发现和护理范式使得稳定的 基于生物学的风险分层和风险适应治疗的改进。该提案利用了 现有的临床试验护理模型旨在研究非生物驱动因素对结果的影响。具体的 假设 HMH 通过三种影响儿童 ALL 复发和生存的机制 化疗给药：(1) 口服化疗的依从性降低，(2) 儿童基础健康状况较差 导致化疗毒性和随后的延迟/剂量减少的状态，以及 (3) 获得药物的机会减少 护理导致更高的住院率，从而延迟化疗的接受。以她的试点工作为基础 博纳博士以混合方法的方式利用其导师团队的跨学科专业知识 提议评估 HMH 是否与儿科 ALL 的较差疾病结局相关，并确定 未来干预措施可以针对的潜在行动机制。在目标 1-3) 博纳博士将 将 HMH 的前瞻性调查研究纳入一项针对新发儿童的 III 期多中心临床试验 诊断 ALL 以确定 HMH 与早期复发率和生存率之间的关联（目标 1）、口服 化疗依从性（目标 2a）、化疗实施（目标 2b）和护理模式（目标 3）。目标 4) Bona 博士将利用家长和提供者访谈来确定 HMH 经验中的目标元素，以 为临床试验环境制定 HMH 干预措施提供信息。

项目成果

Race, ethnicity, and goal-concordance of end-of-life palliative care in pediatric oncology.

儿科肿瘤学临终姑息治疗的种族、民族和目标一致性。

• DOI: 10.1002/cncr.33768
• 发表时间: 2021
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Umaretiya,PujaJ;Li,Anran;McGovern,Alana;Ma,Clement;Wolfe,Joanne;Bona,Kira
• 通讯作者: Bona,Kira

Feasibility of systematic poverty screening in a pediatric oncology referral center.

• DOI: 10.1002/pbc.27380
• 发表时间: 2018-12
• 期刊: Pediatric blood & cancer
• 影响因子: 3.2
• 作者: Zheng DJ;Shyr D;Ma C;Muriel AC;Wolfe J;Bona K
• 通讯作者: Bona K

Oral Mercaptopurine Adherence in Pediatric Acute Lymphoblastic Leukemia: A Survey Study From the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium.

小儿急性淋巴细胞白血病的口服巯嘌呤依从性：丹纳法伯癌症研究所急性淋巴细胞白血病联盟的一项调查研究。

• DOI: 10.1177/27527530221122685
• 发表时间: 2023
• 期刊: Journal of pediatric hematology/oncology nursing
• 作者: Kahn,JustineM;Stevenson,Kristen;Beauchemin,Melissa;Koch,VictoriaB;Cole,PeterD;Welch,JenniferJG;Gage-Bouchard,Elizabeth;Karsenty,Cecile;Silverman,LewisB;Kelly,KaraM;Bona,Kira
• 通讯作者: Bona,Kira

Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia.

儿童急性淋巴细胞白血病多中心临床试验中父母痛苦的差异。

• DOI: 10.1093/jnci/djad099
• 发表时间: 2023
• 期刊: Journal of the National Cancer Institute
• 作者: Umaretiya,PujaJ;Koch,VictoriaB;Flamand,Yael;Aziz-Bose,Rahela;Ilcisin,Lenka;Valenzuela,Ariana;Cole,PeterD;Gennarini,LisaM;Kahn,JustineM;Kelly,KaraM;Tran,ThaiHoa;Michon,Bruno;Welch,JenniferJG;Wolfe,Joanne;Silverman,Lewi
• 通讯作者: Silverman,Lewi

Disparities in pediatric psychosocial oncology utilization.

• DOI: 10.1002/pbc.29342
• 发表时间: 2021-11
• 期刊: Pediatric blood & cancer
• 影响因子: 3.2
• 作者: Zheng DJ;Umaretiya PJ;Schwartz ER;Al-Sayegh H;Raphael JL;van Litsenburg RRL;Ma C;Muriel AC;Bona K
• 通讯作者: Bona K