Although survival in childhood acute lymphoblastic leukemia (ALL) has improved over the years, there remains a need to identify racial, ethnic, and socioeconomic health disparities that contribute to poor outcomes. In a study recently presented at the 63rd American Society of Hematology (ASH) Annual Meeting & Exposition, a team of researchers led by Dr. Sumit Gupta of the University of Toronto investigated the impact of race, ethnicity, and socioeconomic status among young patients with ALL enrolled in Children's Oncology Group studies between 2004 and 2019. The investigators identified significant disparities in survival outcomes in association with these factors. In this interview, Dr. Gupta explains the importance of recognizing health disparities among pediatric patients with ALL and the changes that can be implemented to address them.
Oncology Data Advisor: By way of background, why is research in racial, ethnic, and socioeconomic health disparities important?
Sumit Gupta, MD: I think there's been an increasing awareness over, well, decades, but it's reached more prominence in recent times—in general, disparities in all of those parameters in medicine. I think there are areas of medicine such as childhood ALL where we are fortunate that we actually do pretty well for our children. Sometimes that lulls us into thinking that maybe we don't actually suffer from those same types of disparities as other areas, but of course, that's no guarantee. I think this was, in our view, foundational work to show that even in childhood ALL, even as cure rates have increased, those disparities still seem to exist.
Oncology Data Advisor: Can you comment on the significance of the results of your study?
Dr. Gupta: In the past, studies have shown potential disparities among racial and ethnic groups, but they have said that those are either narrowing over time or are secondary to other factors such as differential distribution of high-risk genetics and socioeconomic status. What our studies and our results show is that this may partially explain some of these inferior outcomes that we're seeing in some racial groups, including non-Hispanic Black children and Hispanic children, but it doesn't seem to explain the whole disparity. I think the significance of the study is that it is not just casting blame on these differences and saying, "Hey, this is because of high-risk leukemia genetics," but it's saying that we actually need to look at other mechanisms, as well.
Oncology Data Advisor: Given these results, how do you recommend that clinicians begin to apply them to their practices?
Dr. Gupta: That's the tricky part, because our study was good at showing that these disparities exist. It hinted at some of the mechanisms that might be at play, but it wasn't designed to say, nor was it able to definitively say, "This is the reason that Hispanic patients do worse" or "This is the reason that non-Hispanic Black patients do worse, and so this is what you should do about it."
I think what clinicians should take away from this is that we are not necessarily that different than other parts of medicine. We can cast a critical eye on our own practices and see if we are potentially, within our systems, treating patients differently depending on their racial, ethnic, or socioeconomic groups. It's also a call to the overall community, specifically the research community, to take these findings and conduct further studies to really try to figure out exactly what the mechanisms are, and therefore design interventions that both mitigate them and are evaluable in turn.
About Dr. Gupta
Sumit Gupta, MD, is a staff oncologist and clinician investigator in the Division of Hematology/Oncology at The Hospital for Sick Children in Toronto, Ontario. He is also an Associate Professor in the Department of Pediatrics in the Institute for Health Policy, Management, and Evaluation at the University of Toronto. Dr. Gupta specializes in the treatment of pediatric patients with cancer. His research focuses on improving the outcomes of vulnerable subpopulations of pediatric cancers, including those in low- and middle-income countries. He serves as Chair of the Unit for Policy and Economics Research in Childhood Cancer and as Associate Chair of the Lancet Oncology Commission on Sustainable Pediatric Cancer Care. He has served as an investigator of several clinical trials and has authored numerous publications in peer-reviewed journals.
For More Information
Gupta S, Teachey DT, Devidas M, et al (2021). Racial, ethnic, and socioeconomic factors result in disparities in outcome among children with acute lymphoblastic leukemia not fully attenuated by disease prognosticators: a Children's Oncology Group (COG) study [oral presentation]. Presented at: 63rd American Society of Hematology Annual Meeting & Exposition. Abstract 211.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.