Disparities in trial enrollment and outcomes of Hispanic adolescent and young adult acute lymphoblastic leukemia

Abstract

In this secondary analysis of Hispanic adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated on Cancer and Leukemia Group B (CALGB) 10403, we evaluated outcomes and geographic enrollment patterns relative to US population data. We used demographic, clinical, and survival data on AYAs enrolled on CALGB 10403 (N = 295, 2007-2012). Surveillance, Epidemiology, and End Results registries provided overall survival (OS) for US AYA ALL by ethnicity/race. North American Association of Cancer Registries provided AYA ALL incidence overall and proportion among Hispanics by US state. Of AYAs enrolled on CALGB 10403, 263 (89%) reported ethnicity/race: 45 (17%) Hispanic, 172 (65%) non-Hispanic White (NHW), 25 (10%) non-Hispanic Black (NHB), and 21 (8%) other. Compared with NHWs, Hispanic and NHB patients had lower household income, and Hispanic patients were more likely to harbor high-risk CRLF2 aberrations. Relative to US estimates, where Hispanic patients represented 46% of newly diagnosed AYA ALL patients and experienced inferior OS compared with NHW (P < .001), Hispanic AYAs on CALGB 10403 did as well as NHW patients (3 year OS, 75% vs 74%; P = NS). Hispanic patients also had higher rates of protocol completion (P = .05). Enrollments on CALGB 10403 differed relative to the distribution of Hispanic AYA ALL in the United States: enrollment was highest in the Midwest; t and only 15% of enrollees were from states with a high proportion of Hispanic AYA ALL patients. In summary, Hispanic patients treated on CALGB 10403 did as well as NHWs and better than population estimates. Geographical misalignment between trial sites and disease epidemiology may partially explain the lower-than-expected enrollment of Hispanic AYA ALL patients.

Impact of Specialized Treatment Setting on Survival in Adolescent and Young Adult ALL

“…The finding that Hispanic patients are less likely than NHW patients to receive treatment at SCCs in both CA and TX highlights disparities in Hispanic ALL treatment that have been noted previously. 23 Unlike other leukemias, ALL has the highest incidence among Hispanic/Latino individuals in the United States 24 ; therefore, we must work hard especially to understand and eradicate access barriers to specialized leukemia care in this patient population. It is unsurprising that health insurance coverage was strongly associated with treatment at an SCC in all three states.…”

BIPOC Experiences of (anti-)Racist Patient Engagement in Adolescent and Young Adult Oncology Research: an Electronic Delphi Study

“…Empirical evidence underscores heightened disparities among BIPOC AYA cancer patients with greater risk of marginalization in recruitment into clinical trials [ 13 ], racially biased communications from cancer care providers [ 14 ] and inferior overall survival outcomes compared with Non-Hispanic White counterparts [ 1 , 15 ]. Since the onset of the COVID-19 pandemic in 2020, the widespread prevalence of COVID-19 has magnified significant disparities in its impact on racially minoritized populations, exacerbating pre-existing social issues related to anti-Black racism and police brutality [ 16 ] as well as anti-Asian racism and violence [ 17 ].…”

Characteristics of Health Care Settings Where Adolescents and Young Adults Receive Care for ALL

“…Among AYAs with ALL, numerous patient-level explanations for inferior outcomes have been suggested (clinical, biological, behavioral), but minimal attention has been given to cancer care delivery. 11,[15][16][17][18][19][20][21] When examining care delivery among AYAs, it is key to do so along the lines of model of care as AYAs are treated in a variety of settings. These range from providing care in an adult/internal medicine (IM) model (adult services/specialists only), a pediatric model (pediatric services/specialists only), or a mixed model (pediatric services/specialists embedded within a general hospital).…”