Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil

Viana, Simone Santana; Lima, Leyla Manoella Maurício Rodrigues de; Nascimento, Juliana Brito do; Cardoso, Carlos André Ferreira; Rosário, Ana Carolina Dantas; Mendonça, Cléverton de Oliveira; Menezes-Neto, Osvaldo Alves de; Cipolotti, Rosana

doi:10.1016/j.leukres.2015.07.007

Cited by 16 publications

(17 citation statements)

References 19 publications

(2 reference statements)

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“…This has been reported in a study from Boston, which reported an incidence of increase in household material insecurity from 20 to 29 per cent after 6 months of therapy in families of children diagnosed with cancer28. Remoteness of residence from the treating centre and rural residence have been shown to adversely affect the outcome in studies from Australia and Brazil2930. Two-thirds of our patients had to travel a distance of >50 km and one-fifth >200 km to access health care.…”

Section: Discussionsupporting

confidence: 66%

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Totadri¹,

Trehan²,

Kaur³

et al. 2019

Indian J Med Res

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Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients’ database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata ( P =0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent ( P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 ( P =0.015); 1.98 ( P =0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.

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Section: Discussionsupporting

confidence: 66%

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Totadri¹,

Trehan²,

Kaur³

et al. 2019

Indian J Med Res

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“…In addition to 5-year overall survival, we assessed early mortality (≤ 30 days after treatment initiation), a quality performance indicator of treatment-related complications. 30 While the national average (5.3%) was much lower than Brazil and Egypt (~20%), 31,32 only 7 states were below the proposed international benchmark of 4%. 14 This relatively easy-to-calculate indicator can be used today to initiate quality improvement interventions by the Mexican Ministry of Health.…”

Section: Discussionmentioning

confidence: 96%

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Muñoz-Aguirre

Huerta-Gutiérrez

Zamora

et al. 2021

Health Systems & Reform

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The aim of the study was to measure survival of children with acute lymphoblastic leukemia (ALL) under Mexico's public health insurance for the population treated under Seguro Popular. A retrospective cohort study using claims data from Mexico's Seguro Popular program, covering cancer treatment from 2005 to 2015 was conducted. Overall 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this program was estimated. From 2005 to 2015, 8,977 children with ALL initiated treatment under Seguro Popular. Under this financing scheme, the annual number of treated children doubled from 535 in 2005 to 1,070 in 2015. The estimates for 5-year overall survival of 61.8% (95%CI 60.8, 62.9) remained constant over time. We observed wide gaps in riskstandardized 5-year overall survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-pediatric specialty hospital (Hazards Ratio, HR = 1.18; 95%CI 1.09, 1.26), facilities without a pediatric oncology/hematology specialist (HR = 2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR = 1.22; 95%CI 1.13, 1.32). In a decade Mexico's Seguro Popular doubled access to ALL treatment for covered children and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year overall survival did not improve over time and did not achieve levels found in comparable countries. Our results provide lessons for Mexico's evolving health system and for countries moving toward universal health coverage.

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“…Even in countries with a high‐quality healthcare system, as in Switzerland, differences in survival persist . Poor adherence to treatment combined with early relapse and toxic death are the major causes of death . The mortality rate of childhood leukemia has however decreased significantly in Brazil .…”

Section: Discussionmentioning

confidence: 99%

“…31,32 Poor adherence to treatment combined with early relapse and toxic death are the major causes of death. 33,34 The mortality rate of childhood leukemia has however decreased significantly in Brazil. 35,36 The Brazilian protocol group for ALL treatment began in the 80s and since then the survival of children with leukemia has improved in some specialized centers.…”

Section: Variablementioning

confidence: 99%

Incidence and survival of childhood leukemia in Recife, Brazil: A population‐based analysis

Lins

Santos

Albuquerque

et al. 2016

Pediatric Blood & Cancer

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Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil

Cited by 16 publications

References 19 publications

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Incidence and survival of childhood leukemia in Recife, Brazil: A population‐based analysis

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